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Bordeanu-Diaconescu EM, Cretu A, Grosu-Bularda A, Andrei MC, Hodea FV, Dumitru CS, Enache V, Creanga CA, Lascar I, Hariga CS. Comprehensive Literature Review on Melanoma of Unknown Primary Site Triggered by an Intriguing Case Report. Diagnostics (Basel) 2024; 14:2210. [PMID: 39410614 PMCID: PMC11475773 DOI: 10.3390/diagnostics14192210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2024] [Revised: 09/20/2024] [Accepted: 09/30/2024] [Indexed: 10/20/2024] Open
Abstract
Melanoma is one of the most aggressive forms of skin cancer. While most melanomas have a discernible primary site, a small subset, approximately 3.2%, present as a metastatic disease without an identifiable primary origin, a condition known as melanoma of unknown primary (MUP). Unusual cases of primary melanoma have also been previously reported in the respiratory, gastrointestinal, and urogenital tracts. MUP typically is found in lymph nodes, subcutaneous sites, and visceral organs, with hypotheses about its origin including spontaneous primary tumor regression and ectopic melanocytes. MUP presents unique challenges in diagnosis and treatment due to the absence of a detectable primary tumor. Understanding its genetic and molecular features, epidemiology, prognostic factors, and treatment options is crucial for optimizing patient care and outcomes in this subset of melanoma patients. We conducted an extensive literature review triggered by a case report of a patient with suspected MUP. A 51-year-old woman was transferred from another hospital where an incision was performed for a suspected superinfected hematoma of the left thigh. Since the patient showed high leukocytosis and redness and swelling of the thigh, local debridement, drainage, and excisional biopsy of the tumor mass were performed in our unit in the emergency setting, and the tumor was taken for histopathology evaluation. Intraoperatively, the mass appeared nonspecific. The permanent histopathology report established a diagnosis of melanoma, with tumor proliferation also involving lymphoid tissue, and despite broad clinical and imagistic assessments, the primary melanoma could not be identified. Clinicians must be aware of the varied clinical manifestations of malignant melanoma, especially in cases of occult melanoma where the primary site is not evident.
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Affiliation(s)
- Eliza-Maria Bordeanu-Diaconescu
- Department of Plastic Surgery and Reconstructive Microsurgery, “Carol Davila” University of Medicine and Pharmacy Bucharest, 010825 Bucharest, Romania; (E.-M.B.-D.); (A.G.-B.); (C.-S.H.)
- Burn Centre, Emergency Clinical Hospital of Bucharest, 014461 Bucharest, Romania
| | - Andrei Cretu
- Department of Plastic Surgery and Reconstructive Microsurgery, “Carol Davila” University of Medicine and Pharmacy Bucharest, 010825 Bucharest, Romania; (E.-M.B.-D.); (A.G.-B.); (C.-S.H.)
| | - Andreea Grosu-Bularda
- Department of Plastic Surgery and Reconstructive Microsurgery, “Carol Davila” University of Medicine and Pharmacy Bucharest, 010825 Bucharest, Romania; (E.-M.B.-D.); (A.G.-B.); (C.-S.H.)
| | - Mihaela-Cristina Andrei
- Department of Plastic Surgery and Reconstructive Microsurgery, “Carol Davila” University of Medicine and Pharmacy Bucharest, 010825 Bucharest, Romania; (E.-M.B.-D.); (A.G.-B.); (C.-S.H.)
| | - Florin-Vlad Hodea
- Department of Plastic Surgery and Reconstructive Microsurgery, “Carol Davila” University of Medicine and Pharmacy Bucharest, 010825 Bucharest, Romania; (E.-M.B.-D.); (A.G.-B.); (C.-S.H.)
| | - Catalina-Stefania Dumitru
- Department of Plastic Surgery and Reconstructive Microsurgery, “Carol Davila” University of Medicine and Pharmacy Bucharest, 010825 Bucharest, Romania; (E.-M.B.-D.); (A.G.-B.); (C.-S.H.)
| | - Valentin Enache
- Department of Anatomical Pathology, Clinical Emergency Hospital of Bucharest, 014461 Bucharest, Romania
| | - Cosmin-Antoniu Creanga
- Department of Anatomical Pathology, Clinical Emergency Hospital of Bucharest, 014461 Bucharest, Romania
| | - Ioan Lascar
- Department of Plastic Surgery and Reconstructive Microsurgery, “Carol Davila” University of Medicine and Pharmacy Bucharest, 010825 Bucharest, Romania; (E.-M.B.-D.); (A.G.-B.); (C.-S.H.)
| | - Cristian-Sorin Hariga
- Department of Plastic Surgery and Reconstructive Microsurgery, “Carol Davila” University of Medicine and Pharmacy Bucharest, 010825 Bucharest, Romania; (E.-M.B.-D.); (A.G.-B.); (C.-S.H.)
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2
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Syed MU, Stephen SJ, Rahman AA. Radiologic overview of sinonasal lesions. FRONTIERS IN RADIOLOGY 2024; 4:1445701. [PMID: 39280982 PMCID: PMC11392720 DOI: 10.3389/fradi.2024.1445701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/07/2024] [Accepted: 08/09/2024] [Indexed: 09/18/2024]
Abstract
Sinonasal tumors are often malignant and comprise approximately 3% of all head and neck malignancies. Half of these tumors arise in the nasal cavity, and other common locations of origin include the ethmoid and maxillary sinuses. Some unique clinical features are anosmia and altered phonation but the most common general features include headache, epistaxis, and diplopia. CT and MRI may be used to assess tumor location, invasion of adjacent tissue, presence of metastasis, internal tumor heterogeneity, and contrast enhancement. Local invasion of the tumor beyond the sinonasal tract can impact adjacent structures such as the cranial nerves, skull base, branches of the internal carotid artery, and orbit leading to neurologic signs, facial pain, and diplopia. Imaging is used in the diagnosis, staging, and treatment planning of sinonasal tumors. This collection of benign and malignant sinonasal tumors will include some rare and unique cases with an emphasis on imaging features demonstrating a wide variety of pathologies.
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Affiliation(s)
- Mohammed U Syed
- University of Rochester School of Medicine and Dentistry, Rochester, NY, United States
| | - Steve J Stephen
- University of Rochester School of Medicine and Dentistry, Rochester, NY, United States
| | - Akm A Rahman
- Department of Imaging Sciences, University of Rochester Medical Center, Rochester, NY, United States
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3
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Mg S, Cd A, Verma S, S N, John JJ. Amelanotic Malignant Melanoma With Atypical Divergent Neuroendocrine Differentiation: A Report of an Unusual and Rare Case of Anorectal Bleeding. Cureus 2024; 16:e66905. [PMID: 39280438 PMCID: PMC11401631 DOI: 10.7759/cureus.66905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2024] [Accepted: 08/14/2024] [Indexed: 09/18/2024] Open
Abstract
Melanocytes located between the anal transition zone and the dentate line of the anal canal can give rise to the uncommon malignant tumor known as anal melanoma. It has a fast-paced clinical course and can masquerade as several common anorectal symptoms, such as hemorrhoids or rectal ulcers. In melanoma, divergent differentiation is a very uncommon phenomenon. The diagnosis of melanoma is difficult with histopathology sections alone (hematoxylin and eosin, H&E). Special stains and ancillary immunohistochemistry investigations are useful in these situations. A 60-year-old female patient presented to the surgical outpatient department with complaints of anorectal bleeding. After clinical evaluation, a growth in the anorectal region was identified, and a biopsy was taken from the growth. Histopathological and subsequent immunohistochemical analysis of the biopsy material was done at the Department of Pathology. A diagnosis of amelanotic melanoma with atypical and divergent neuroendocrine differentiation involving the anorectal region was rendered. Histologically, this tumor showed extremely pleomorphic polygonal to elongated spindle cells that co-expressed neuroendocrine markers and were positive for S100, HMB-45, and Melan-A. This case presented many diagnostic challenges at both the histomorphological level and the immunohistochemical expression profile analysis. We will go into great depth regarding the diagnostic challenges in this instance and provide an outline of our approach. The immunohistochemical and prognostic importance of this case will also be covered.
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Affiliation(s)
- Shamiliprabha Mg
- Department of Pathology, Sri Ramaswamy Memorial (SRM) Medical College Hospital and Research Centre, SRM Institute of Science and Technology (SRMIST), Chengalpattu, IND
| | - Anand Cd
- Department of Pathology, Sri Ramaswamy Memorial (SRM) Medical College Hospital and Research Centre, SRM Institute of Science and Technology (SRMIST), Chengalpattu, IND
| | - Supriya Verma
- Department of Pathology, Sri Ramaswamy Memorial (SRM) Medical College Hospital and Research Centre, SRM Institute of Science and Technology (SRMIST), Chengalpattu, IND
| | - Nivethitha S
- Department of Pathology, Sri Ramaswamy Memorial (SRM) Medical College Hospital and Research Centre, SRM Institute of Science and Technology (SRMIST), Chengalpattu, IND
| | - Jaison J John
- Department of Pathology, Sri Ramaswamy Memorial (SRM) Medical College Hospital and Research Centre, SRM Institute of Science and Technology (SRMIST), Chengalpattu, IND
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4
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Kimura K, Yamamoto T, Tsuchiya J, Yoshida S, Yanai S, Onishi I, Fujii Y, Tateishi U. A diagnostic approach of various urethral diseases using multimodal imaging findings: comprehensive overview. Abdom Radiol (NY) 2024:10.1007/s00261-024-04435-0. [PMID: 38896251 DOI: 10.1007/s00261-024-04435-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Revised: 06/05/2024] [Accepted: 06/06/2024] [Indexed: 06/21/2024]
Abstract
In clinical practice, urethral diseases are not as frequent as conditions affecting other components of the urinary system. Radiological imaging tests, such as retrograde urethrography, CT, MRI, and PET/CT, along with patient history, are crucial for accurately assessing relatively rare urethral lesions. This article aimed to provide a comprehensive overview of urethral lesions, from traumatic changes to neoplasms, and discuss the multimodal imaging findings of various urethral lesions that radiologists should know. To this end, the normal imaging anatomy of the urethra and a step-by-step approach that can be used in clinical practice have been presented to help in the systematic understanding of urethral lesions.
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Affiliation(s)
- Koichiro Kimura
- Department of Diagnostic Radiology, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-Ku, Tokyo, 113-8510, Japan.
| | - Tatsuya Yamamoto
- Department of Diagnostic Imaging, Cancer Institute Hospital of JFCR, Tokyo, Japan
| | - Junichi Tsuchiya
- Department of Diagnostic Radiology, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-Ku, Tokyo, 113-8510, Japan
| | - Soichiro Yoshida
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Shuichi Yanai
- Department of Radiology, Fraternity Memorial Hospital, Tokyo, Japan
| | - Iichiro Onishi
- Department of Pathology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yasuhisa Fujii
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Ukihide Tateishi
- Department of Diagnostic Radiology, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-Ku, Tokyo, 113-8510, Japan
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Cochran BL, Eliseo S, Vaughn A, Van Der Horn TL, Ferrara E, Edwards J. Treated Primary Cutaneous Malignant Melanoma With Later Metastasis Found in Clinical Presentation of Left Axilla Lymphadenopathy: A Case Report. Cureus 2024; 16:e54694. [PMID: 38389566 PMCID: PMC10883347 DOI: 10.7759/cureus.54694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/21/2024] [Indexed: 02/24/2024] Open
Abstract
This case report details the rare instance of metastatic spread of cutaneous malignant melanoma to the breast in a 50-year-old female. The patient presented with a palpable axillary mass confirmed to be metastasis despite excision and closure of the primary malignancy. The mass seen in clinical and radiological presentations presented with features of complicated differentiation from a primary breast tumor. Biopsy and staining with immunohistochemical markers S100 and Sox10 played a critical role in confirming the melanocytic origin of this metastatic lesion. Breast metastases are associated with poor prognosis, and this case emphasizes the importance of in-depth evaluations for patients with a history of malignant melanoma and the need for ongoing clinical awareness in this field.
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Affiliation(s)
- Brigitte L Cochran
- Osteopathic Medicine, Philadelphia College of Osteopathic Medicine, Moultrie, USA
| | - Sara Eliseo
- Osteopathic Medicine, Philadelphia College of Osteopathic Medicine, Moultrie, USA
| | - Austin Vaughn
- Radiology, Lake Erie College of Osteopathic Medicine, Bradenton, USA
| | | | - Enzo Ferrara
- Osteopathic Medicine, Philadelphia College of Osteopathic Medicine, Suwanee, USA
| | - Jamie Edwards
- Interventional Radiology, St. Vincent's Medical Center, Jacksonville, USA
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6
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Saeidi Z, Giti R, Rostami M, Mohammadi F. Nanotechnology-Based Drug Delivery Systems in the Transdermal Treatment of Melanoma. Adv Pharm Bull 2023; 13:646-662. [PMID: 38022807 PMCID: PMC10676549 DOI: 10.34172/apb.2023.070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Revised: 01/15/2023] [Accepted: 01/20/2023] [Indexed: 12/01/2023] Open
Abstract
The incidence rate of melanoma is dramatically increasing worldwide, raising it to the fifth most common cancer in men and the sixth in women currently. Resistance generally occurs to the agents used in chemotherapy; besides their high toxicity destroys the normal cells. This study reviewed a detailed summary of the structure, advantages, and disadvantages of nanotechnology-based drug delivery systems in the treatment of melanoma, as well as some nanocarrier applications in animal models or clinical studies. Respective databases were searched for the target keywords and 93 articles were reviewed and discussed. A close study of the liposomes, niosomes, transferosomes, ethosomes, transethosomes, cubosomes, dendrimers, cyclodextrins, solid lipid nanoparticles, and carbon nanotubes (CNTs) was conducted. It was found that these nanocarriers could inhibit metastasis and migration of melanoma cells and decrease cell viability. Conclusively, some nanocarriers like liposomes, niosomes, and transferosomes have been discussed as superior to conventional therapies for melanoma treatment.
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Affiliation(s)
- Zahra Saeidi
- Department of Pharmaceutics, School of Pharmacy, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Rashin Giti
- Department of Prosthodontics, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mehdi Rostami
- Department of Pharmaceutics, School of Pharmacy, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Farhad Mohammadi
- Department of Pharmaceutics, School of Pharmacy, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
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7
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El Homsi M, Golia Pernicka JS, Lall C, Nougaret S, Paspulati RM, Pickhardt PJ, Sheedy SP, Petkovska I. Beyond squamous cell carcinoma: MRI appearance of uncommon anal neoplasms and mimickers. Abdom Radiol (NY) 2023; 48:2898-2912. [PMID: 37027015 PMCID: PMC10775174 DOI: 10.1007/s00261-023-03891-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 03/16/2023] [Accepted: 03/17/2023] [Indexed: 04/08/2023]
Abstract
Anal cancer is an uncommon malignancy. In addition to squamous cell carcinoma, there are a variety of other less common malignancies and benign pathologies that may afflict the anal canal, with which abdominal radiologists should be familiar. Abdominal radiologists should be familiar with the imaging features that can help distinguish different rare anal tumors beyond squamous cell carcinoma and that can aid in diagnosis therefore help steer management. This review discusses these uncommon pathologies with a focus on their imaging appearance, management, and prognosis.
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Affiliation(s)
- Maria El Homsi
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Jennifer S Golia Pernicka
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Chandana Lall
- Department of Radiology, University of Florida College of Medicine, Jacksonville, FL, USA
| | - Stephanie Nougaret
- Department of Radiology, Montpellier Cancer Research Institute (IRCM), Montpellier, France
| | - Raj M Paspulati
- Department of Radiology, Moffitt Cancer Center, Tampa, FL, USA
| | - Perry J Pickhardt
- Department of Radiology, University of Wisconsin School of Medicine & Public Health, Madison, WI, USA
| | | | - Iva Petkovska
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA.
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8
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Elouali I, Imrani K, Berrada K, Zahi H, Jahid A, Moatassim Billah N, Nassar I. Primitive rectal melanoma: A rare case report. SAGE Open Med Case Rep 2023; 11:2050313X231194150. [PMID: 37654557 PMCID: PMC10467173 DOI: 10.1177/2050313x231194150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Accepted: 07/26/2023] [Indexed: 09/02/2023] Open
Abstract
Mucosal melanoma is a rare subtype of melanoma distinct from the cutaneous type in its clinical and biological aspects, requiring different therapeutical management. Anorectal melanomas represent less than 1% of anorectal cancers and 0.3% of malignant melanomas, and they are by far the most studied type. Proctologic examination, colonoscopy, and biopsy can establish a correct diagnosis. Imaging techniques, especially MRI can show some characteristic features, but it is essentially performed for extension assessment. We report the case of a 63-year-old man who consulted for rectal bleeding. The proctological examination found a brownish ulcerative-vegetating tumor of 3 cm in diameter located 3 cm from the anal rim. The endoscopic examination revealed a predominance of ulcerative budding lesions and the biopsy specimen confirmed a rectal melanoma. The extension assessment, based on a computed tomography scan and MRI did not show locoregional or distant metastases. Radiotherapy and abdominoperineal resection with pelvic node dissection was the treatment of choice with good evolution.
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Affiliation(s)
- Ibtissam Elouali
- Central Radiology Department, IBN SINA University Hospital V, Rabat, Morocco
| | - Kawtar Imrani
- Central Radiology Department, IBN SINA University Hospital V, Rabat, Morocco
| | - Kenza Berrada
- Central Radiology Department, IBN SINA University Hospital V, Rabat, Morocco
| | - Hiba Zahi
- Central Radiology Department, IBN SINA University Hospital V, Rabat, Morocco
| | - Ahmed Jahid
- Histopathology Department, IBN SINA University Hospital V, Rabat, Morocco
| | | | - Ittimade Nassar
- Central Radiology Department, IBN SINA University Hospital V, Rabat, Morocco
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9
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Liu H, Wang X, Su M, Wang N, Xian J. Differentiating sinonasal malignant melanoma from squamous cell carcinoma using DWI combined with conventional MRI. Neuroradiology 2023:10.1007/s00234-023-03164-3. [PMID: 37208530 DOI: 10.1007/s00234-023-03164-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 05/03/2023] [Indexed: 05/21/2023]
Abstract
PURPOSE This study aimed to investigate the feasibility of diffusion-weighted imaging (DWI) in combination with conventional MRI features to differentiate sinonasal malignant melanoma (SNMM) from sinonasal squamous cell carcinoma (SNSCC). METHODS A total of 37 patients with SNMM and 44 patients with SNSCC were retrospectively reviewed. Conventional MRI features and apparent diffusion coefficients (ADCs) were evaluated independently by two experienced head and neck radiologists. ADCs were obtained from two different regions of interest (ROIs) including maximum slice (MS) and small solid sample (SSS). Multivariate logistic regression analysis was performed to identify significant MR imaging features in discriminating between SNMM and SNSCC. Receiver operating characteristic (ROC) curves were used to assess the diagnostic performance. RESULTS SNMMs were more frequently located in the nasal cavity, with well-defined border, T1 Septate Pattern (T1-SP) and heterogeneous T1 hyperintensity, whereas SNSCCs were more frequently located in the paranasal sinus, with homogenous T1 isointensity, ill-defined border, reticular or linear T2 hyperintensity, and pterygopalatine fossa or orbital involvement (all p < 0.05). The mean ADCs of SNMM (MS ADC, 0.85 × 10-3mm2/s; SSS ADC, 0.69 × 10-3mm2/s) were significantly lower than those of SNSCC (MS ADC, 1.05 × 10-3mm2/s; SSS ADC, 0.82 × 10-3mm2/s) (p < 0.05). With a combination of location, T1 signal intensity, reticular or linear T2 hyperintensity, and a cut-off MS ADC of 0.87 × 10-3mm2/s, the sensitivity, specificity, and AUC were 97.3%, 68.2%, and 0.89, respectively. CONCLUSION DWI combined with conventional MRI can effectively improve the diagnostic performance in differentiating SNMM from SNSCC.
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Affiliation(s)
- Hangzhi Liu
- Department of Radiology, Beijing Tongren Hospital, Capital Medical University, No. 1, DongJiaoMinXiang Street, DongCheng District, Beijing, 100730, China
| | - Xinyan Wang
- Department of Radiology, Beijing Tongren Hospital, Capital Medical University, No. 1, DongJiaoMinXiang Street, DongCheng District, Beijing, 100730, China
| | - Mingyue Su
- Department of Radiology, Beijing Tongren Hospital, Capital Medical University, No. 1, DongJiaoMinXiang Street, DongCheng District, Beijing, 100730, China
| | - Ning Wang
- Department of Radiology, Beijing Tongren Hospital, Capital Medical University, No. 1, DongJiaoMinXiang Street, DongCheng District, Beijing, 100730, China
| | - Junfang Xian
- Department of Radiology, Beijing Tongren Hospital, Capital Medical University, No. 1, DongJiaoMinXiang Street, DongCheng District, Beijing, 100730, China.
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10
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Rossi E, Schinzari G, Cellini F, Balducci M, Pasqualoni M, Maiorano BA, Fionda B, Longo S, Deodato F, Di Stefani A, Peris K, Gambacorta MA, Tortora G. Dabrafenib-Trametinib and Radiotherapy for Oligoprogressive BRAF Mutant Advanced Melanoma. Biomedicines 2023; 11:biomedicines11020394. [PMID: 36830931 PMCID: PMC9953646 DOI: 10.3390/biomedicines11020394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 01/20/2023] [Accepted: 01/25/2023] [Indexed: 01/31/2023] Open
Abstract
The clinical management of metastatic melanoma has been changed by BRAF (BRAFi) and MEK inhibitors (MEKi), which represent a standard treatment for BRAF-mutant melanoma. In oligoprogressive melanoma patients with BRAF mutations, target therapy can be combined with loco-regional radiotherapy (RT). However, the association of BRAF/MEK inhibitors and RT needs to be carefully monitored for potential increased toxicity. Despite the availability of some reports regarding the tolerability of RT + target therapy, data on simultaneous RT and BRAFi/MEKi are limited and mostly focused on the BRAFi vemurafenib. Here, we report a series of metastatic melanoma patients who received fractioned RT regimens for oligoprogressive disease in combination with the BRAFi dabrafenib and the MEKi trametinib, which have continued beyond progression. None of the cases developed relevant adverse events while receiving RT or interrupted dabrafenib and trametinib administration. These cases suggest that a long period of dabrafenib/trametinib interruption during radiotherapy for oligoprogressive disease can be avoided. Prospective trials are warranted to assess the efficacy and safety of the contemporary administration of BRAF/MEK inhibitors and radiotherapy for oligoprogressive disease.
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Affiliation(s)
- Ernesto Rossi
- Medical Oncology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
- Correspondence: or
| | - Giovanni Schinzari
- Medical Oncology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
- Medical Oncology, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Francesco Cellini
- Radioterapia Oncologica ed Ematologia, Dipartimento di Diagnostica per Immagini, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
- Radioterapia Oncologica ed Ematologia, Dipartimento Universitario Diagnostica per Immagini, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Mario Balducci
- Radioterapia Oncologica ed Ematologia, Dipartimento di Diagnostica per Immagini, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | | | - Brigida Anna Maiorano
- Oncology Unit, IRCCS Foundation Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo, Italy
| | - Bruno Fionda
- Radioterapia Oncologica ed Ematologia, Dipartimento di Diagnostica per Immagini, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Silvia Longo
- Radioterapia Oncologica ed Ematologia, Dipartimento di Diagnostica per Immagini, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Francesco Deodato
- Radioterapia Oncologica ed Ematologia, Dipartimento Universitario Diagnostica per Immagini, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
- UOC Radioterapia Oncologica Molise ART, Gemelli Molise Hospital, 86100 Campobasso, Italy
| | - Alessandro Di Stefani
- Dermatology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Ketty Peris
- Dermatology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
- Dermatology, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Maria Antonietta Gambacorta
- Radioterapia Oncologica ed Ematologia, Dipartimento di Diagnostica per Immagini, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
- Radioterapia Oncologica ed Ematologia, Dipartimento Universitario Diagnostica per Immagini, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Giampaolo Tortora
- Medical Oncology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
- Medical Oncology, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
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11
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Jeong C, Kim J, Han IH, Kim S, Choi I, Kim H, Jeong JH, Bae H. Melittin derived peptide-drug conjugate, M-DM1, inhibits tumor progression and induces effector cell infiltration in melanoma by targeting M2 tumor-associated macrophages. Front Immunol 2023; 14:1178776. [PMID: 37122692 PMCID: PMC10140360 DOI: 10.3389/fimmu.2023.1178776] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 03/30/2023] [Indexed: 05/02/2023] Open
Abstract
Background Melanoma has the highest mortality rate among all the types of skin cancer. In melanoma, M2-like tumor-associated macrophages (TAMs) are associated with the invasiveness of tumor cells and a poor prognosis. Hence, the depletion or reduction of M2-TAMs is a therapeutic strategy for the inhibition of tumor progression. The aim of this study was to evaluate the therapeutic effects of M-DM1, which is a conjugation of melittin (M), as a carrier for M2-like TAMs, and mertansine (DM1), as a payload to induce apoptosis of TAMs, in a mouse model of melanoma. Methods Melittin and DM1 were conjugated and examined for the characterization of M-DM1 by high-performance liquid chromatography and electrospray ionization mass spectrometry. Synthesized M-DM1 were examined for in vitro cytotoxic effects. For the in vivo study, we engrafted murine B16-F10 into right flank of C57BL/6 female mice and administered an array of treatments (PBS, M, DM1, or M-DM1 (20 nmol/kg)). Subsequently, the tumor growth and survival rates were analyzed, as well as examining the phenotypes of tumor-infiltrating leukocytes and expression profiles. Results M-DM1 was found to specifically reduce M2-like TAMs in melanoma, which potentially leads to the suppression of tumor growth, migration, and invasion. In addition, we also found that M-DM1 improved the survival rates in a mouse model of melanoma compared to M or DM1 treatment alone. Flow cytometric analysis revealed that M-DM1 enhanced the infiltration of CD8+ cytotoxic T cells and natural killer cells (NK cells) in the tumor microenvironment. Conclusion Taken together, our findings highlight that M-DM1 is a prospective agent with enhanced anti-tumor effects.
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Affiliation(s)
- Chanmi Jeong
- Department of Physiology, College of Korean Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Jeongdong Kim
- Twinpig Biolab Inc. Research & Development Center, Seoul, Republic of Korea
- College of Pharmacy, Yonsei Institute of Pharmaceutical Sciences, Yonsei University, Incheon, Republic of Korea
| | - Ik-Hwan Han
- Department of Physiology, College of Korean Medicine, Kyung Hee University, Seoul, Republic of Korea
- Convergence Innovation Support Center, Gangwon Technopark, Chuncheon-si, Gangwon-do, Republic of Korea
| | - Soyoung Kim
- Department of Physiology, College of Korean Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Ilseob Choi
- Department of Physiology, College of Korean Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Hongsung Kim
- Department of Physiology, College of Korean Medicine, Kyung Hee University, Seoul, Republic of Korea
- Department of Korean Medicine, College of Korean Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Jin-Hyun Jeong
- College of Pharmacy, Yonsei Institute of Pharmaceutical Sciences, Yonsei University, Incheon, Republic of Korea
- *Correspondence: Jin-Hyun Jeong, ; Hyunsu Bae,
| | - Hyunsu Bae
- Department of Physiology, College of Korean Medicine, Kyung Hee University, Seoul, Republic of Korea
- Twinpig Biolab Inc. Research & Development Center, Seoul, Republic of Korea
- *Correspondence: Jin-Hyun Jeong, ; Hyunsu Bae,
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12
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Gao Y, Hou Q, Guo R, Ying J, Xiong J, Jiang H. Effect of Sun exposure-induced ferroptosis mechanisms on pathology and potential biological processes of primary melanoma by microarray data analysis. Front Genet 2022; 13:998792. [PMID: 36226170 PMCID: PMC9548870 DOI: 10.3389/fgene.2022.998792] [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] [Received: 07/21/2022] [Accepted: 09/06/2022] [Indexed: 11/13/2022] Open
Abstract
Objectives: Sunlight exposure is an important environmental factor in the pathogenesis of skin cutaneous melanoma (SKCM). Ultraviolet (UV) from sunlight can cause excessive intracellular production of reactive oxygen species (ROS), resulting in damage from oxidative stress to cells. As a major iron-rich and ROS-producing organelle, mitochondria are considered as an important place for cell ferroptosis. Thus, the pathology and potential biological process of UV exposure-induced ferroptosis in the development of SKCM has aroused our strong interest.Methods: Gene expression profile datasets of melanoma cell line datasets (GSE31909) and UV-irradiated mitochondria dataset (GSE3632) were downloaded from the Gene Expression Omnibus (GEO) database, and ferroptosis-related genes were obtained from the FerrDb v2 database. After identifying the common differentially expressed genes (DEGs), comprehensive analyzes were performed, including functional annotation, protein-protein interaction (PPI) network construction, hub gene identification, and gene and tissue protein expression levels, survival analysis, and immune cell infiltration analysis.Results: A total of 14 common DEGs was identified for subsequent analyses. Seven DEGs, including PSMB4, CRELD2, CDKN2A, TIMP1, NDRG1, ATF3 and JUND, have consistent performance in mRNA and protein expression in normal skin and SKCM tissues can be regarded as a good biomarker with SKCM diagnostic effectiveness. Functional enrichment analysis results indicate that HIF-1 signaling pathway and angiogenesis involved in the pathogenesis and development of SKCM. Induction of ferroptosis in tumor cells by enhancing the function of CD8+ T cells is expected to be an effective intervention to promote tumor therapy.Conclusion: Our study reveals the pathogenesis and potential biological processes of UV exposure-induced ferroptosis in the development of SKCM, which may provide potential immunotherapy targets for SKCM treatment via tumor cell ferroptosis mechanisms.
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Affiliation(s)
| | | | | | | | | | - Hua Jiang
- *Correspondence: Jiachao Xiong, ; Hua Jiang,
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13
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Shi YJ, Yang X, Yan S, Li XT, Wei YY, Zhang XY, Sun YS. Primary malignant melanoma of the esophagus: differentiation from esophageal squamous cell carcinoma and leiomyoma using dynamic contrast-enhanced CT findings. Abdom Radiol (NY) 2022; 47:2747-2759. [PMID: 35668195 PMCID: PMC9300547 DOI: 10.1007/s00261-022-03556-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 05/10/2022] [Accepted: 05/10/2022] [Indexed: 01/18/2023]
Abstract
PURPOSE This study aimed to summarize the computed tomography (CT) findings of PMME and differentiate it from esophageal SCC and leiomyoma using CT analysis. METHODS This was a retrospective study including 23 patients with PMME, 69 patients with SCC, and 21 patients with leiomyoma in our hospital. Qualitative CT morphological characteristics of each lesion included the location, tumor range, ulcer, enhanced pattern, and so on. For quantitative CT analysis, thickness, length and area of tumor, size of largest lymph node, number of metastatic lymph node, and CT value of tumor in plain, arterial, and delayed phases were measured. The associated factors for differentiating PMME from SCC and leiomyoma were examined with univariate and multivariate analysis. Receive operating characteristic curve (ROC) was used to determine the performance of CT models in discriminating PMME from SCC and leiomyoma. RESULTS The thickness, mean CT value in arterial phase, and range of tumor were the independent factors for diagnosing PMME from SCC. These parameters were used to establish a diagnostic CT model with area under the ROC (AUC) of 0.969, and accuracy of 90.2%. In pathology, interstitial vessels in PMME were more abundant than that of SCC, and the stromal fibrosis was more obvious in SCC. PMME commonly exhibited intraluminal expansively growth pattern and SCC often showed infiltrative pattern. The postcontrast attenuation difference in maximum CT attenuation value between plain and arterial phases was the independent factor for diagnosing PMME from leiomyoma. This parameter was applied to differentiate PMME from leiomyoma with AUC of 0.929 and accuracy of 86.4%. CONCLUSION The qualitative and quantitative CT analysis had excellent performance for differentiating PMME from SCC and esophageal leiomyoma.
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Affiliation(s)
- Yan-Jie Shi
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Radiology, Peking University Cancer Hospital & Institute, No. 52 Fu Cheng Road, Hai Dian District, Beijing, 100142, China
| | - Xin Yang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Pathology, Peking University Cancer Hospital & Institute, No. 52 Fu Cheng Road, Hai Dian District, Beijing, 100142, China
| | - Shuo Yan
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Radiology, Peking University Cancer Hospital & Institute, No. 52 Fu Cheng Road, Hai Dian District, Beijing, 100142, China
| | - Xiao-Ting Li
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Radiology, Peking University Cancer Hospital & Institute, No. 52 Fu Cheng Road, Hai Dian District, Beijing, 100142, China
| | - Yi-Yuan Wei
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Radiology, Peking University Cancer Hospital & Institute, No. 52 Fu Cheng Road, Hai Dian District, Beijing, 100142, China
| | - Xiao-Yan Zhang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Radiology, Peking University Cancer Hospital & Institute, No. 52 Fu Cheng Road, Hai Dian District, Beijing, 100142, China
| | - Ying-Shi Sun
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Radiology, Peking University Cancer Hospital & Institute, No. 52 Fu Cheng Road, Hai Dian District, Beijing, 100142, China.
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14
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Fernandes MC, Shoushtari A, Leitao MM, Herman Chui M, Al-Ahmadie H, Petkovska I. Metastatic melanoma concurrent to the urinary bladder and endometrium: Case report. J Med Imaging Radiat Oncol 2022; 66:643-646. [PMID: 34850582 PMCID: PMC9923725 DOI: 10.1111/1754-9485.13356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 11/03/2021] [Indexed: 01/19/2023]
Abstract
We report a case of a 47-year-old woman with a history of acral lentiginous melanoma, left great toe subungual primary, metastatic to the lungs, brain, and spleen, presenting with lower urinary tract symptoms. She had also palpated and removed a dark mass from her vaginal canal. Magnetic resonance imaging (MRI) showed polypoidal lesions within the urinary bladder and the endometrium. The suspected differential diagnosis was endometrial and bladder melanoma metastases, based on her cancer history and MRI findings. The patient underwent cystoscopy with transurethral resection of the bladder tumor and endometrial biopsy, and pathology was consistent with metastatic melanoma. Bladder and endometrial metastatic lesions are exceedingly rare. Herein, we describe an unusual case of metastatic melanoma concurrent to the urinary bladder and endometrium.
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Affiliation(s)
- Maria Clara Fernandes
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York City, New York, USA
| | - Alexander Shoushtari
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York City, New York, USA
| | - Mario M Leitao
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York City, New York, USA
| | - M. Herman Chui
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York City, New York, USA
| | - Hikmat Al-Ahmadie
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York City, New York, USA
| | - Iva Petkovska
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York City, New York, USA
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15
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Granata V, Simonetti I, Fusco R, Setola SV, Izzo F, Scarpato L, Vanella V, Festino L, Simeone E, Ascierto PA, Petrillo A. Management of cutaneous melanoma: radiologists challenging and risk assessment. LA RADIOLOGIA MEDICA 2022; 127:899-911. [PMID: 35834109 DOI: 10.1007/s11547-022-01522-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 06/27/2022] [Indexed: 02/07/2023]
Abstract
Melanoma patient remains a challenging for the radiologist, due to the difficulty related to the management of a patient more often in an advanced stage of the disease. It is necessary to determine a stratification of risk, optimizing the means, with diagnostic tools that should be optimized in relation to the type of patient, and improving knowledge. Staging and risk assessment procedures are determined by disease presentation at diagnosis. Melanoma staging is a critical tool to assist clinical decision-making and prognostic assessment. It is used for clinical trial design, eligibility, stratification, and analysis. The current standard for regional lymph nodes staging is represented by the sentinel lymph node excision biopsy procedure. For staging of distant metastases, PET-CT has the highest sensitivity and diagnostic odds ratio. Similar trend is observed during melanoma surveillance. The advent of immunotherapy, which has improved patient outcome, however, has determined new issues for radiologists, partly due to atypical response patterns, partly due to adverse reactions that must be identified as soon as possible for the correct management of the patient. The main objectives of the new ir-criteria are to standardize the assessment between different trials. However, these ir-criteria do not take into account all cases of atypical response patterns, as hyperprogression or dissociated responses. None of these criteria has actually been uniformly adopted in routine. The immune-related adverse events (irAEs) can involve various organs from head to toe. It is crucial for radiologists to know the imaging appearances of this condition, to exclude recurrent or progressive disease and for pneumonitis, since it could be potentially life-threatening toxicity, resulting in pneumonitis-related deaths in early phase trials, to allow a proper patient management.
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Affiliation(s)
- Vincenza Granata
- Radiology Division, "Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale, Naples, Italia", Via Mariano Semmola, Naples, Italy.
| | - Igino Simonetti
- Radiology Division, "Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale, Naples, Italia", Via Mariano Semmola, Naples, Italy
| | | | - Sergio Venanzio Setola
- Radiology Division, "Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale, Naples, Italia", Via Mariano Semmola, Naples, Italy
| | - Francesco Izzo
- Hepatobiliary Surgical Oncology Division, "Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale, Naples, Italia",, Via Mariano Semmola, Naples, Italy
| | - Luigi Scarpato
- Department of Skin Cancers, Cancer Immunotherapy and Development Therapeutics, Istituto Nazionale Tumori IRCCS Fondazione Pascale, Naples, Italy
| | - Vito Vanella
- Department of Skin Cancers, Cancer Immunotherapy and Development Therapeutics, Istituto Nazionale Tumori IRCCS Fondazione Pascale, Naples, Italy
| | - Lucia Festino
- Department of Skin Cancers, Cancer Immunotherapy and Development Therapeutics, Istituto Nazionale Tumori IRCCS Fondazione Pascale, Naples, Italy
| | - Ester Simeone
- Department of Skin Cancers, Cancer Immunotherapy and Development Therapeutics, Istituto Nazionale Tumori IRCCS Fondazione Pascale, Naples, Italy
| | - Paolo Antonio Ascierto
- Department of Skin Cancers, Cancer Immunotherapy and Development Therapeutics, Istituto Nazionale Tumori IRCCS Fondazione Pascale, Naples, Italy
| | - Antonella Petrillo
- Radiology Division, "Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale, Naples, Italia", Via Mariano Semmola, Naples, Italy
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16
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Fine GC, Covington MF, Koppula BR, Salem AE, Wiggins RH, Hoffman JM, Morton KA. PET-CT in Clinical Adult Oncology-VI. Primary Cutaneous Cancer, Sarcomas and Neuroendocrine Tumors. Cancers (Basel) 2022; 14:2835. [PMID: 35740501 PMCID: PMC9221374 DOI: 10.3390/cancers14122835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 06/03/2022] [Accepted: 06/06/2022] [Indexed: 11/16/2022] Open
Abstract
PET-CT is an advanced imaging modality with many oncologic applications, including staging, therapeutic assessment, restaging and surveillance for recurrence. The goal of this series of six review articles is to provide practical information to providers and imaging professionals regarding the best use of PET-CT for specific oncologic indications, the potential pitfalls and nuances that characterize these applications, and guidelines for image interpretation. Tumor-specific clinical information and representative PET-CT images are provided. The current, sixth article in this series addresses PET-CT in an evaluation of aggressive cutaneous malignancies, sarcomas and neuroendocrine tumors. A discussion of the role of FDG PET for all types of tumors in these categories is beyond the scope of this review. Rather, this article focuses on the most common malignancies in adult patients encountered in clinical practice. It also focuses on Food and Drug Agency (FDA)-approved and clinically available radiopharmaceuticals rather than research tracers or those requiring a local cyclotron. This information will serve as a guide to primary providers for the appropriate role of PET-CT in managing patients with cutaneous malignancies, sarcomas and neuroendocrine tumors. The nuances of PET-CT interpretation as a practical guide for imaging providers, including radiologists, nuclear medicine physicians and their trainees, are also addressed.
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Affiliation(s)
- Gabriel C. Fine
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT 84132, USA; (G.C.F.); (M.F.C.); (B.R.K.); (A.E.S.); (R.H.W.); (J.M.H.)
| | - Matthew F. Covington
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT 84132, USA; (G.C.F.); (M.F.C.); (B.R.K.); (A.E.S.); (R.H.W.); (J.M.H.)
| | - Bhasker R. Koppula
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT 84132, USA; (G.C.F.); (M.F.C.); (B.R.K.); (A.E.S.); (R.H.W.); (J.M.H.)
| | - Ahmed Ebada Salem
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT 84132, USA; (G.C.F.); (M.F.C.); (B.R.K.); (A.E.S.); (R.H.W.); (J.M.H.)
- Faculty of Medicine, Department of Radiodiagnosis and Intervention, Alexandria University, Alexandria 21526, Egypt
| | - Richard H. Wiggins
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT 84132, USA; (G.C.F.); (M.F.C.); (B.R.K.); (A.E.S.); (R.H.W.); (J.M.H.)
| | - John M. Hoffman
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT 84132, USA; (G.C.F.); (M.F.C.); (B.R.K.); (A.E.S.); (R.H.W.); (J.M.H.)
| | - Kathryn A. Morton
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT 84132, USA; (G.C.F.); (M.F.C.); (B.R.K.); (A.E.S.); (R.H.W.); (J.M.H.)
- Intermountain Healthcare Hospitals, Summit Physician Specialists, Murray, UT 84123, USA
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17
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Zhou L, Yang Y, Si L, Chi Z, Sheng X, Lian B, Wang X, Tang B, Mao L, Yan X, Li S, Bai X, Guo J, Cui C. Phase II study of apatinib combined with temozolomide in patients with advanced melanoma after failure of immunotherapy. Melanoma Res 2022; 32:142-149. [PMID: 35190519 DOI: 10.1097/cmr.0000000000000809] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Treatment for advanced melanoma after progression on immunotherapy is limited. This phase II trial (NCT03422445) was conducted to evaluate the efficacy and safety of apatinib plus temozolomide in patients with advanced melanoma after failure of immunotherapy. Patients with unresectable stage III or stage IV melanoma after progression on immunotherapy were treated with temozolomide 300 mg on days 1-5 and apatinib 500 mg daily every 28-day cycle until disease progression or intolerable toxicities. Besides immunotherapy, prior chemotherapy, targeted therapy, and clinical trials were allowed. The primary endpoint was progression-free survival. Secondary endpoints were objective response rate, disease control rate, overall survival, and safety. Of 29 patients, 28 (96.6%) had metastatic diseases, and the predominant subtypes were mucosal [12 (41.4%)] and acral melanoma [eight (27.6%)]. Five (17.2%) patients showed BRAF, CKIT, or NRAS mutation. Five achieved confirmed partial response, with an objective response rate of 17.2%. The disease control rate was 82.8%. The median progression-free survival was 5.0 months [95% confidence interval (CI): 4.7-5.3], and the median overall survival was 10.1 months (95% CI: 5.1-15.0). Grade 3-4 treatment-related adverse events included proteinuria [four (13.8%)], thrombocytopenia [two (6.9%)], hypertension [one (3.4%)], and hyperbilirubinemia [one (3.4%)]. No treatment-related death occurred. Apatinib plus temozolomide demonstrated promising efficacy and manageable safety profile in patients with advanced melanoma after progression on immunotherapy.
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Affiliation(s)
- Li Zhou
- Department of Renal Cancer and Melanoma, Peking University Cancer Hospital and Institute, Beijing, China
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18
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Switzer B, Puzanov I, Skitzki JJ, Hamad L, Ernstoff MS. Managing Metastatic Melanoma in 2022: A Clinical Review. JCO Oncol Pract 2022; 18:335-351. [PMID: 35133862 PMCID: PMC9810138 DOI: 10.1200/op.21.00686] [Citation(s) in RCA: 96] [Impact Index Per Article: 48.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Cutaneous melanoma remains the most lethal of the primary cutaneous neoplasms, and although the incidence of primary melanoma continues to rise, the mortality from metastatic disease remains unchanged, in part through advances in treatment. Major developments in immunomodulatory and targeted therapies have provided robust improvements in response and survival trends that have transformed the clinical management of patients with metastatic melanoma. Additional advances in immunologic and cancer cell biology have contributed to further optimization in (1) risk stratification, (2) prognostication, (3) treatment, (4) toxicity management, and (5) surveillance approaches for patients with an advanced melanoma diagnosis. In this review, we provide a comprehensive overview of the historical and future advances regarding the translational and clinical implications of advanced melanoma and share multidisciplinary recommendations to aid clinicians in the navigation of current treatment approaches for a variety of patient cohorts.
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Affiliation(s)
- Benjamin Switzer
- Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | - Igor Puzanov
- Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | - Joseph J. Skitzki
- Department of Surgical Oncology, Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | - Lamya Hamad
- Department of Pharmacy, Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | - Marc S. Ernstoff
- ImmunoOncology Branch, Developmental Therapeutics Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, Rockville, MD,Marc S. Ernstoff, MD, National Cancer Institute, Rockville, MD 20850; e-mail:
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Saleh M, Javadi S, Elsherif S, Patnana M, Sagebiel TL, Torres-Cabala C, Matei J, Bhosale P, Faria SC. Multimodality Imaging and Genetics of Primary Mucosal Melanomas and Response to Treatment. Radiographics 2021; 41:1954-1972. [PMID: 34678102 DOI: 10.1148/rg.2021210063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Mucosal melanomas (MMs) are rare and aggressive tumors that arise from melanocytes in the mucosal tissues that line the respiratory, gastrointestinal, and urogenital tracts. Most MMs occur during the 6th and 7th decades of life. MMs may be asymptomatic but may also cause bleeding, pain, and itching, depending on the site of origin. Because of their asymptomatic or oligosymptomatic nature and the difficulty of visualizing them in some cases, they are often advanced tumors at patient presentation. MM staging varies depending on the site of the primary tumor. A simplified staging system allows classification of clinically localized disease as stage I, regional nodal involvement as stage II, and distant metastasis as stage III. MM differs genetically from its cutaneous counterparts. Common drivers in cutaneous melanoma such as B-raf proto-oncogene serine/threonine kinase (BRAF) have a lower mutation rate in MM, whereas mutations of other genes including the KIT proto-oncogene, receptor tyrosine kinase (KIT) and splicing factor 3b subunit 1 gene (SF3B1) are more common in MM. Complete resection is the best curative option. However, surgical intervention with wide local excision and negative margins may be difficult to attain because of the local anatomy and the extent of disease. In addition, despite aggressive surgical resection, most patients develop local recurrence and metastatic disease. Recent advances in the treatment of melanoma include immunotherapy and targeted therapy. Unfortunately, MMs have a relatively poor prognosis, with an overall 5-year survival rate of 25%. Online supplemental material is available for this article. ©RSNA, 2021.
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Affiliation(s)
- Mohammed Saleh
- From the Departments of Abdominal Imaging (M.S., S.J., M.P., T.L.S., P.B., S.C.F.), Pathology (C.T.C.), Dermatology (C.T.C.), and Melanoma Oncology (J.M.), The University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030-4008; and Department of Radiology, The University of Florida College of Medicine, Jacksonville, Fla (S.E.)
| | - Sanaz Javadi
- From the Departments of Abdominal Imaging (M.S., S.J., M.P., T.L.S., P.B., S.C.F.), Pathology (C.T.C.), Dermatology (C.T.C.), and Melanoma Oncology (J.M.), The University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030-4008; and Department of Radiology, The University of Florida College of Medicine, Jacksonville, Fla (S.E.)
| | - Sherif Elsherif
- From the Departments of Abdominal Imaging (M.S., S.J., M.P., T.L.S., P.B., S.C.F.), Pathology (C.T.C.), Dermatology (C.T.C.), and Melanoma Oncology (J.M.), The University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030-4008; and Department of Radiology, The University of Florida College of Medicine, Jacksonville, Fla (S.E.)
| | - Madhavi Patnana
- From the Departments of Abdominal Imaging (M.S., S.J., M.P., T.L.S., P.B., S.C.F.), Pathology (C.T.C.), Dermatology (C.T.C.), and Melanoma Oncology (J.M.), The University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030-4008; and Department of Radiology, The University of Florida College of Medicine, Jacksonville, Fla (S.E.)
| | - Tara L Sagebiel
- From the Departments of Abdominal Imaging (M.S., S.J., M.P., T.L.S., P.B., S.C.F.), Pathology (C.T.C.), Dermatology (C.T.C.), and Melanoma Oncology (J.M.), The University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030-4008; and Department of Radiology, The University of Florida College of Medicine, Jacksonville, Fla (S.E.)
| | - Carlos Torres-Cabala
- From the Departments of Abdominal Imaging (M.S., S.J., M.P., T.L.S., P.B., S.C.F.), Pathology (C.T.C.), Dermatology (C.T.C.), and Melanoma Oncology (J.M.), The University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030-4008; and Department of Radiology, The University of Florida College of Medicine, Jacksonville, Fla (S.E.)
| | - Jane Matei
- From the Departments of Abdominal Imaging (M.S., S.J., M.P., T.L.S., P.B., S.C.F.), Pathology (C.T.C.), Dermatology (C.T.C.), and Melanoma Oncology (J.M.), The University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030-4008; and Department of Radiology, The University of Florida College of Medicine, Jacksonville, Fla (S.E.)
| | - Priya Bhosale
- From the Departments of Abdominal Imaging (M.S., S.J., M.P., T.L.S., P.B., S.C.F.), Pathology (C.T.C.), Dermatology (C.T.C.), and Melanoma Oncology (J.M.), The University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030-4008; and Department of Radiology, The University of Florida College of Medicine, Jacksonville, Fla (S.E.)
| | - Silvana C Faria
- From the Departments of Abdominal Imaging (M.S., S.J., M.P., T.L.S., P.B., S.C.F.), Pathology (C.T.C.), Dermatology (C.T.C.), and Melanoma Oncology (J.M.), The University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030-4008; and Department of Radiology, The University of Florida College of Medicine, Jacksonville, Fla (S.E.)
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20
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Cheng GC, Osinski T, Miyamoto H, Frye TP. Primary adrenal melanoma: A case report and review of the literature. JOURNAL OF CLINICAL UROLOGY 2021. [DOI: 10.1177/20514158211032056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Galen C Cheng
- Department of Urology, University of Rochester Medical Center, USA
| | - Thomas Osinski
- Department of Urology, University of Rochester Medical Center, USA
| | - Hiroshi Miyamoto
- Department of Urology, University of Rochester Medical Center, USA
- Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, USA
| | - Thomas P Frye
- Department of Urology, University of Rochester Medical Center, USA
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21
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Vergara IA, Wilmott JS, Long GV, Scolyer RA. Genetic drivers of non-cutaneous melanomas: Challenges and opportunities in a heterogeneous landscape. Exp Dermatol 2021; 31:13-30. [PMID: 33455025 DOI: 10.1111/exd.14287] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 12/16/2020] [Accepted: 01/13/2021] [Indexed: 12/13/2022]
Abstract
Non-cutaneous melanomas most frequently involve the uveal tract and mucosal membranes, including the conjunctiva. In contrast to cutaneous melanoma, they often present at an advanced clinical stage, are associated with worse clinical outcomes and show poorer responses to immunotherapy. The mutational load within most non-cutaneous melanomas reflects their lower ultraviolet light (UV) exposure. The genetic drivers within non-cutaneous melanomas are heterogeneous. Within ocular melanomas, posterior uveal tract melanomas typically harbour one of two distinct, sets of driver mutations and alterations of clinical and biological significance. In contrast to posterior uveal tract melanomas, anterior uveal tract melanomas of the iris and conjunctival melanomas frequently carry both a higher mutational burden and specific mutations linked with UV exposure. The genetic drivers in iris melanomas more closely resemble those of the posterior uveal tract, whereas conjunctival melanomas harbour similar genetic driver mutations to cutaneous melanomas. Mucosal melanomas occur in sun-shielded sites including sinonasal and oral cavities, nasopharynx, oesophagus, genitalia, anus and rectum, and their mutational landscape is frequently associated with a dominant process of spontaneous deamination and infrequent presence of UV mutation signatures. Genetic drivers of mucosal melanomas are diverse and vary with anatomic location. Further understanding of the causes of already identified recurrent molecular events in non-cutaneous melanomas, identification of additional drivers in specific subtypes, integrative multi-omics analyses and analysis of the tumor immune microenvironment will expand knowledge in this field. Furthermore, such data will likely uncover new therapeutic strategies which will lead to improved clinical outcomes in non-cutaneous melanoma patients.
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Affiliation(s)
- Ismael A Vergara
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - James S Wilmott
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Georgina V Long
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,Royal North Shore and Mater Hospitals, Sydney, NSW, Australia
| | - Richard A Scolyer
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital and New South Wales Health Pathology, Sydney, NSW, Australia
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22
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Xia Y, Xie J, Zhao J, Lou Y, Cao D. Screening and Identification of Key Biomarkers in Melanoma: Evidence from Bioinformatic Analyses. J Comput Biol 2020; 28:317-329. [PMID: 32985909 DOI: 10.1089/cmb.2019.0400] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Melanoma is an extremely malignant and occult tumor. To identify candidate genes related to melanoma carcinogenesis and progression, the microarray data sets GSE83583, GSE130244, and GSE31879 were retrieved from the Gene Expression Omnibus (GEO) database using the GEO2R analytical tool provided by the National Center for Biotechnology Information (NCBI). Gene expression analysis was carried out using the DAVID database for Gene Ontology and Kyoto Encyclopedia of Genes and Genomes functional enrichment analyses of differentially expressed genes. A protein-protein interaction network was constructed with the STRING database, the interaction data were imported into Cytoscape software, and the network topology was analyzed to identify key genes. Hub gene expression was verified in the Gene Expression Profiling Interactive Analysis and Human Protein Atlas databases. In addition, Kaplan-Meier survival analysis was performed on hub genes. A total of 142 differentially expressed genes were identified in melanoma tissues, including 50 upregulated genes and 92 downregulated genes. Five central genes (CCNA2, EBP, GABBR2, TRIM32, and ADAM10) were found based on the degree of the nodes. These genes are mainly enriched in protein serine/threonine kinase activity and apoptosis pathways. Survival analysis showed CCNA2 to be related to the overall survival (OS) of patients, and increased expression of TRIM32 led to increased OS and disease-free survival risk. Bioinformatics methods can be used to effectively select key genes in melanoma, and CCNA2 and TRIM32 may be new targets for treatment of this disease.
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Affiliation(s)
- Yijun Xia
- Department of Plastic and Reconstructive Surgery, Anhui Medical University, The Second Affiliated Hospital, Hefei, Anhui, China
| | - Juan Xie
- Department of Plastic and Reconstructive Surgery, Anhui Medical University, The Second Affiliated Hospital, Hefei, Anhui, China
| | - Jun Zhao
- Department of Plastic and Reconstructive Surgery, Anhui Medical University, The Second Affiliated Hospital, Hefei, Anhui, China
| | - Yin Lou
- Department of Plastic and Reconstructive Surgery, Anhui Medical University, The Second Affiliated Hospital, Hefei, Anhui, China
| | - Dongsheng Cao
- Department of Plastic and Reconstructive Surgery, Anhui Medical University, The Second Affiliated Hospital, Hefei, Anhui, China
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23
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Leong JY, Clark CB, Syed A, Hubosky SG. Palliative Endoscopic Treatment of Metastatic Uveal Melanoma to the Upper and Lower Urinary Tract. Urology 2020; 142:e49-e51. [DOI: 10.1016/j.urology.2020.04.075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 04/15/2020] [Indexed: 11/25/2022]
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24
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Unruh B, Holbert B. Case Report: Anorectal Melanoma - A Rare Entity. Semin Roentgenol 2020; 56:206-209. [PMID: 33858647 DOI: 10.1053/j.ro.2020.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Bradley Unruh
- Wake Forest Baptist Hospital Radiology Resident, Winston-Salem, North Carolina, USA.
| | - Brenda Holbert
- Wake Forest Baptist Hospital Radiology, Department of Abdominal Imaging Faculty, Winston-Salem, North Carolina, USA
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25
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Abstract
Glomus tumors are benign tumors typically located in the subcutis or deep dermis of the subungual region of the fingers. Histologically, glomus tumors are divided into three subtypes, in descending order of frequency: solid glomus tumor, glomangioma and glomangiomyoma. We report a case of a symptomatic intracapsular juxtasynovial glomangiomyoma of the knee. To the best of our knowledge, this location of this uncommon histological subtype of glomus tumor has not been reported previously. Although the final diagnosis is made by histopathology, the radiologist should consider this rare lesion in the differential of highly vascularised synovial-based masses.
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26
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Papp T, Ferenczi Z, Petro M, Meszar Z, Kepes Z, Berenyi E. Disorders of neural crest derivates in oncoradiological practice. Transl Cancer Res 2019; 8:2916-2923. [PMID: 35117049 PMCID: PMC8799273 DOI: 10.21037/tcr.2019.10.38] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Accepted: 08/28/2019] [Indexed: 02/03/2023]
Abstract
Hundreds of articles discuss the imaging characteristics and molecular background of prominent gastrointestinal (GI) motility disorders and tumors of the peripheral nervous system, but according to our knowledge an article focusing on the classification and developmental background of these heterogeneous diseases is not to be found. Our aim is to give insight on the common features of several diseases and tumors, starting with their common source of origin, the neural crest (NC). The NC is a transient cell population of the embryo, which differentiates into several organs/structures of our body (sympathetic trunk, adrenal medulla). Although the incidence of the individual tumors of NC cells is not high by themselves, the summation of these incidences may be relevant in the daily routine. In the introduction we mention the most prominent developmental routes and molecular pathways of NC cells, which is crucial to understand the pathogenesis and the wide range of involved cell types from the colon to the adrenal gland. We summarized the most important, useful pathological findings and imaging techniques from the X-ray to the positron emission tomography—computed tomography (CT) in order to help the identification of these diseases. This article may help to better understand NC lineage and its unique, diverse role during ontogeny, which may influence the radiologists to change several convictions, or understand better the background and/or connections of a wide range of tumors and syndromes.
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Affiliation(s)
- Tamas Papp
- Department of Medical Imaging, Histology and Embryology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Zsuzsanna Ferenczi
- Department of Medical Imaging, Histology and Embryology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Matyas Petro
- Department of Medical Imaging, Histology and Embryology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Zoltan Meszar
- Department of Anatomy, Histology and Embryology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Zita Kepes
- Department of Medical Imaging, Histology and Embryology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Ervin Berenyi
- Department of Medical Imaging, Histology and Embryology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
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27
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Krajnak K, Waugh S. Systemic Effects of Segmental Vibration in an Animal Model of Hand-Arm Vibration Syndrome. J Occup Environ Med 2018; 60:886-895. [PMID: 30020212 PMCID: PMC6173648 DOI: 10.1097/jom.0000000000001396] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVE Epidemiology suggests that occupational exposure to hand-transmitted (segmental) vibration has local and systemic effects. This study used an animal model of segmental vibration to characterize the systemic effects of vibration. METHODS Male Sprague Dawley rats were exposed to tail vibration for 10 days. Genes indicative of inflammation, oxidative stress, and cell cycle, along were measured in the heart, kidney, prostate, and liver. RESULTS Vibration increased oxidative stress and pro-inflammatory gene expression, and decreased anti-oxidant enzymes in heart tissue. In the prostate and liver, vibration resulted in changes in the expression of pro-inflammatory factors and genes involved in cell cycle regulation. CONCLUSIONS These changes are consistent with epidemiological studies suggesting that segmental vibration has systemic effects. These effects may be mediated by changes in autonomic nervous system function, and/or inflammation and oxidative stress.
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Affiliation(s)
- Kristine Krajnak
- Engineering Controls and Technology Branch, Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Morgantown, Washington
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28
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Ercolino GR, Guglielmi G, Pazienza L, Urbano F, Palladino D, Simeone A. Gallbladder and small bowel metastasis of regressive melanoma: a case report. BJR Case Rep 2018; 5:20180032. [PMID: 31131119 PMCID: PMC6519491 DOI: 10.1259/bjrcr.20180032] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 06/21/2018] [Accepted: 06/25/2018] [Indexed: 02/03/2023] Open
Abstract
Malignant melanoma development in gastrointestinal (GI) tract may be primary or secondary. Although small bowel, colon and stomach represent common GI sites affected from metastatic cutaneous malignant melanoma (cMM), more than 90% of the cases are identified only during autoptic examinations. Therefore, the diagnosis in a living patient of gallbladder metastasis from cMM is considered extremely rare. We aimed to describe a case of metastatic melanoma involving the gallbladder, the stomach and the small bowel in a 78-year-old male with diffuse abdominal pain and a history of cMM of the back, which was radically resected 4 years before. Abdominal ultrasound showed intracholecystic multiple nodulations. CT, besides confirming the gallbladder nodules, revealed multiple masses in the stomach, duodenum and ileum. Malignant melanoma lesions were confirmed by histopathological and immunohistochemical analyses of bioptic material obtained from endoscopic examination. In patients with history of melanoma, careful inspection of GI tract should be prompted adopting adequate imaging techniques and endoscopy in order to better influence treatment planning and prognosis.
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Affiliation(s)
| | | | - Luca Pazienza
- Department of Radiology, Scientific Institute Hospital "Casa Sollievo della Sofferenza", San Giovanni Rotondo, Italy
| | - Filomena Urbano
- Department of Radiology, Scientific Institute Hospital "Casa Sollievo della Sofferenza", San Giovanni Rotondo, Italy
| | - Diego Palladino
- Department of Radiology, Scientific Institute Hospital "Casa Sollievo della Sofferenza", San Giovanni Rotondo, Italy
| | - Anna Simeone
- Department of Radiology, Scientific Institute Hospital "Casa Sollievo della Sofferenza", San Giovanni Rotondo, Italy
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29
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JOURNAL CLUB: Primary Anorectal Melanoma: MRI Findings and Clinicopathologic Correlations. AJR Am J Roentgenol 2018; 211:W98-W108. [PMID: 29927334 DOI: 10.2214/ajr.17.18807] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of this study is to evaluate the MRI features of primary anorectal malignant melanoma and to correlate these features with its clinical and pathologic characteristics. MATERIALS AND METHODS The medical records of 12 patients (five men and seven women; mean age [± SD], 60.8 ± 10.0 years) with pathologically proven primary anorectal melanoma were retrospectively reviewed. MRI findings were analyzed to determine the shape, size, distance from the anal verge, presence of perirectal or anal infiltration, signal intensity on T1- and T2-weighted images, presence of diffusion restriction, contrast enhancement pattern of the lesion, presence of lymphadenopathy, and occurrence of bowel obstruction. Subsequent follow-up data for the patients were recorded. RESULTS The most common presentation was hematochezia (41.7% of patients). Common findings on MRI included a large intraluminal polypoid mass (75.0% of lesions) with little perirectal or anal infiltration (100.0%), T1 hyperintensity (66.7%), high T2 signal intensity (54.5%) or mixed T2 signal intensity (45.5%), restricted diffusion (100.0%), and hyper-enhancement (100.0%). The mean length, width, and depth of these masses were 3.5, 2.9, and 2.3 cm, respectively. The mean distance from the anal verge was 1.8 cm. Lymphadenopathy was frequently identified (75.0% of cases), with lymph nodes larger than 2 cm noted in 28.5% of cases and most commonly involving the perirectal area (77.8% of cases). No colonic obstructions were observed. The mean patient follow-up was 32.7 months. A total of 25.0% of patients died as a result of disease progression. CONCLUSION The possibility of the presence of anorectal melanoma should be considered for patients with a bulky intraluminal polypoid mass in the anorectum without colonic obstruction, with the mass showing T1 hyperintensity, high or mixed signal T2 intensity, hyperenhancement, minimal perirectal or anal infiltration, and lymphadenopathy.
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30
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Kawaguchi M, Kato H, Tomita H, Mizuta K, Aoki M, Hara A, Matsuo M. Imaging Characteristics of Malignant Sinonasal Tumors. J Clin Med 2017; 6:jcm6120116. [PMID: 29211048 PMCID: PMC5742805 DOI: 10.3390/jcm6120116] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Revised: 12/01/2017] [Accepted: 12/04/2017] [Indexed: 12/13/2022] Open
Abstract
Malignancies of the nasal cavity and paranasal sinuses account for 1% of all malignancies and 3% of malignancies of the upper aerodigestive tract. In the sinonasal tract, nearly half of all malignancies arise in the nasal cavity, whereas most of the remaining malignancies arise in the maxillary or ethmoid sinus. Squamous cell carcinoma is the most common histological subtype of malignant tumors occurring in this area, followed by other epithelial carcinomas, lymphomas, and malignant soft tissue tumors. Although many of these tumors present with nonspecific symptoms, each tumor exhibits characteristic imaging features. Although complex anatomy and various normal variants of the sinonasal tract cause difficulty in identifying the origin and extension of large sinonasal tumors, the invasion of vital structures such as the brain, optic nerves, and internal carotid artery affects patients’ prognosis. Thus, diagnostic imaging plays a key role in predicting the histological subtype and in evaluating a tumor extension into adjacent structures. This article describes the computed tomography and magnetic resonance imaging findings for malignant sinonasal tumors.
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Affiliation(s)
- Masaya Kawaguchi
- Department of Radiology, Gifu University School of Medicine, 1-1 Yanagido, Gifu 501-1194, Japan.
- Department of Tumor Pathology, Gifu University School of Medicine, Gifu 501-1194, Japan.
| | - Hiroki Kato
- Department of Radiology, Gifu University School of Medicine, 1-1 Yanagido, Gifu 501-1194, Japan.
| | - Hiroyuki Tomita
- Department of Tumor Pathology, Gifu University School of Medicine, Gifu 501-1194, Japan.
| | - Keisuke Mizuta
- Department of Otolaryngology, Gifu University School of Medicine, Gifu 501-1194, Japan.
| | - Mitsuhiro Aoki
- Department of Otolaryngology, Gifu University School of Medicine, Gifu 501-1194, Japan.
| | - Akira Hara
- Department of Tumor Pathology, Gifu University School of Medicine, Gifu 501-1194, Japan.
| | - Masayuki Matsuo
- Department of Radiology, Gifu University School of Medicine, 1-1 Yanagido, Gifu 501-1194, Japan.
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