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Doerschner M, Pekar-Lukacs A, Messerli-Odermatt O, Dommann-Scherrer C, Rütti M, Müller AM, Nair G, Kamarachev J, Kerl K, Beer M, Messerli M, Frauenknecht K, Haralambieva E, Hoetzenecker W, French LE, Guenova E. Interferon alfa-2a maintenance after salvage autologous stem cell transplantation in atypical mycosis fungoides with central nervous system involvement. Br J Dermatol 2019; 181:1296-1302. [PMID: 30565216 DOI: 10.1111/bjd.17535] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/12/2018] [Indexed: 01/05/2023]
Abstract
Mycosis fungoides (MF) is a primary cutaneous T-cell lymphoma with unfavourable prognosis for patients with advanced stages of the disease. Refractory disease and advanced-stage disease require systemic therapy. We report on a rare case of an atypical predominantly CD8+ folliculotropic MF, a subtype of MF with poorer prognosis, in a 59-year-old woman. She was initially diagnosed with MF restricted to the skin, of T3N0M0B0/stage IIB according to the current World Health Organization-European Organisation for Research and Treatment of Cancer classification. First-line treatment with local percutaneous radiotherapy in combination with systemic interferon alfa-2a resulted in complete remission. However, 21 months later the disease progressed to T3N0M1B0/stage IVB with development of cerebral manifestation and thus very poor prognosis. Allogeneic stem cell transplantation (SCT) was not a therapeutic option due to the lack of a suitable donor. We initiated methotrexate and cytarabine chemotherapy, followed by high-dose chemotherapy with thiotepa and carmustine with autologous SCT. Despite rapid response and complete remission of the cerebral lesions, disease recurrence of the skin occurred soon after. Interestingly, readministration of interferon alfa-2a as a maintenance treatment after the salvage autologous SCT resulted in a durable complete remission during the follow-up period of currently 17 months after autologous SCT. What's already known about this topic? Mycosis fungoides is a primary cutaneous T-cell lymphoma with unfavourable prognosis for the advanced stages of the disease. A refractory course of disease requires systemic therapy. What does this study add? We report on an unusual case of a patient with mycosis fungoides with cerebral involvement, in which a durable complete remission was achieved upon autologous stem cell therapy and interferon alfa-2a maintenance therapy.
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Affiliation(s)
- M Doerschner
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
| | - A Pekar-Lukacs
- Department of Oncology and Pathology, Lund University, Lund, Sweden
| | | | - C Dommann-Scherrer
- Institute of Pathology, Canton Hospital Winterthur, Winterthur, Switzerland
| | - M Rütti
- Division of Hematology, University Hospital Zurich, Zurich, Switzerland
| | - A M Müller
- Division of Hematology, University Hospital Zurich, Zurich, Switzerland
| | - G Nair
- Division of Hematology, University Hospital Zurich, Zurich, Switzerland
| | - J Kamarachev
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
| | - K Kerl
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
| | - M Beer
- Department of Pathology and Molecular Pathology, University Hospital Zurich, Zurich, Switzerland
| | - M Messerli
- Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland
| | - K Frauenknecht
- Institute of Neuropathology, University of Zurich, University Hospital Zurich, Zurich, Switzerland
| | - E Haralambieva
- Department of Pathology and Molecular Pathology, University Hospital Zurich, Zurich, Switzerland
| | - W Hoetzenecker
- Department of Dermatology, University Hospital Linz, Linz, Austria
| | - L E French
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
| | - E Guenova
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
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Roider E, Signer C, Fehrenbacher B, Metzler G, Schaller M, Kamarachev J, Kerl K, Balabanov S, Jochum W, Hoetzenecker W, Cozzio A, French LE, Dummer R, Guenova E. Individualized treatment approaches for Langerhans cell histiocytosis. Br J Dermatol 2017; 178:1423-1424. [PMID: 29194560 DOI: 10.1111/bjd.16171] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- E Roider
- Department of Dermatology, University Hospital Zürich, University of Zürich, Zürich, Switzerland
| | - C Signer
- Department of Dermatology, Venerology and Allergology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - B Fehrenbacher
- Department of Dermatology, University Hospital Tübingen, Tübingen, Germany
| | - G Metzler
- Institute of Pathology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - M Schaller
- Institute of Pathology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - J Kamarachev
- Department of Dermatology, University Hospital Zürich, University of Zürich, Zürich, Switzerland
| | - K Kerl
- Department of Dermatology, University Hospital Zürich, University of Zürich, Zürich, Switzerland
| | - S Balabanov
- Department of Hematology and Oncology, University Hospital Zürich, University of Zürich, Zürich, Switzerland
| | - W Jochum
- Institute of Pathology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - W Hoetzenecker
- Department of Dermatology, Kepler University Hospital, Linz, Austria
| | - A Cozzio
- Department of Dermatology, Venerology and Allergology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - L E French
- Department of Dermatology, University Hospital Zürich, University of Zürich, Zürich, Switzerland
| | - R Dummer
- Department of Dermatology, University Hospital Zürich, University of Zürich, Zürich, Switzerland
| | - E Guenova
- Department of Dermatology, University Hospital Zürich, University of Zürich, Zürich, Switzerland.,Department of Dermatology, Venerology and Allergology, Kantonsspital St. Gallen, St. Gallen, Switzerland.,Department of Dermatology, University Hospital Tübingen, Tübingen, Germany
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Kunz M, Urosevic-Maiwald M, Goldinger S, Frauchiger A, Dreier J, Belloni B, Mangana J, Jenni D, Dippel M, Cozzio A, Guenova E, Kamarachev J, French L, Dummer R. Efficacy and safety of oral alitretinoin in severe oral lichen planus - results of a prospective pilot study. J Eur Acad Dermatol Venereol 2015; 30:293-8. [DOI: 10.1111/jdv.13444] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Accepted: 09/04/2015] [Indexed: 11/29/2022]
Affiliation(s)
- M. Kunz
- Department of Dermatology; University Hospital Zurich; Zurich Switzerland
| | | | - S.M. Goldinger
- Department of Dermatology; University Hospital Zurich; Zurich Switzerland
| | - A.L. Frauchiger
- Department of Dermatology; University Hospital Zurich; Zurich Switzerland
| | - J. Dreier
- Department of Dermatology; University Hospital Zurich; Zurich Switzerland
| | - B. Belloni
- Department of Dermatology; University Hospital Zurich; Zurich Switzerland
| | - J. Mangana
- Department of Dermatology; University Hospital Zurich; Zurich Switzerland
| | - D. Jenni
- Department of Dermatology; University Hospital Zurich; Zurich Switzerland
| | - M. Dippel
- MD Medscript; Health Care Consulting and Writing; Bad Durkheim Germany
| | - A. Cozzio
- Department of Dermatology; University Hospital Zurich; Zurich Switzerland
| | - E. Guenova
- Department of Dermatology; University Hospital Zurich; Zurich Switzerland
| | - J. Kamarachev
- Department of Dermatology; University Hospital Zurich; Zurich Switzerland
| | - L.E. French
- Department of Dermatology; University Hospital Zurich; Zurich Switzerland
| | - R. Dummer
- Department of Dermatology; University Hospital Zurich; Zurich Switzerland
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Casparis S, Borm JM, Tektas S, Kamarachev J, Locher MC, Damerau G, Grätz KW, Stadlinger B. Oral lichen planus (OLP), oral lichenoid lesions (OLL), oral dysplasia, and oral cancer: retrospective analysis of clinicopathological data from 2002-2011. Oral Maxillofac Surg 2015; 19:149-156. [PMID: 25308326 DOI: 10.1007/s10006-014-0469-y] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2013] [Accepted: 10/06/2014] [Indexed: 06/04/2023]
Abstract
INTRODUCTION This 10-year retrospective study analyzed the incidence of malignant transformation of oral lichen planus (OLP). The study also included dysplasia and oral lichenoid lesion (OLL) in the initial biopsy as a potential differential diagnosis. MATERIAL AND METHODS A total of 692 scalpel biopsies were taken from 542 patients (207 [38.2%] men and 335 [61.8%] women). Clinical and histopathological parameters were analyzed. RESULTS The parameters gender (p = 0.022) and smoking behavior (p < 0.001) were significantly associated with the severity of diagnosis. Mucosal lesions with an ulcerative appearance (p = 0.006) and those located on the floor of the mouth (p < 0.001) showed significantly higher degrees of dysplasia or were diagnosed as oral squamous cell carcinoma (OSCC). Smoking and joint disease appeared to be significant risk factors. Treatment with tretinoin in different concentrations (0.005-0.02%) significantly improved diagnosis. Twelve patients (8 female, 4 male) showed malignant transformation to OSCC within an average period of 1.58 years. The malignant transformation rate (MTR) was higher for OLL (4.4%) than OLP (1.2%). If the first biopsy showed intraepithelial neoplasia, the risk of developing OSCC increased (by 3.5% for squamous intraepithelial neoplasia (SIN) II and by 6.7% for SIN III). CONCLUSION Although we cannot rule out that OLP is a premalignant oral condition, we can confirm that OLP had the lowest MTR of all diagnoses.
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Affiliation(s)
- S Casparis
- Department of Cranio-Maxillofacial and Oral Surgery, University Hospital Zurich, Plattenstrasse 15, 8032, Zurich, Switzerland,
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Mitteldorf C, Bieri M, Wey N, Kerl K, Kamarachev J, Pfaltz M, Kutzner H, Roncador G, Tomasini D, Kempf W. Expression of programmed death-1 (CD279) in primary cutaneous B-cell lymphomas with correlation to lymphoma entities and biological behaviour. Br J Dermatol 2013; 169:1212-8. [DOI: 10.1111/bjd.12579] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/01/2013] [Indexed: 12/12/2022]
Affiliation(s)
- C. Mitteldorf
- Department of Dermatology; Klinikum Hildesheim GmbH; Hildesheim Germany
| | - M. Bieri
- Department of Pathology; University Hospital Zürich; Zürich Switzerland
| | - N. Wey
- Department of Pathology; University Hospital Zürich; Zürich Switzerland
| | - K. Kerl
- Department of Dermatology; University Hospital Zürich; Zürich Switzerland
| | - J. Kamarachev
- Department of Dermatology; University Hospital Zürich; Zürich Switzerland
| | - M. Pfaltz
- Department of Psychiatry and Psychotherapy; University Hospital Zürich; Zürich Switzerland
- Kempf und Pfaltz; Histologische Diagnostik; Research Unit; Seminarstrasse 1 CH-8042 Zürich Switzerland
| | - H. Kutzner
- Dermatopathologie Friedrichshafen Bodensee; Friedrichshafen Germany
| | - G. Roncador
- Centro Nacional de Investigaciones Oncologicas; Madrid Spain
| | - D. Tomasini
- Department of Dermatology; Hospital of Busto Arsizio; Busto Arsizio Italy
| | - W. Kempf
- Department of Dermatology; University Hospital Zürich; Zürich Switzerland
- Kempf und Pfaltz; Histologische Diagnostik; Research Unit; Seminarstrasse 1 CH-8042 Zürich Switzerland
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Abstract
Background The origin of collagen autoimmune diseases is not fully understood. Some studies postulate a mechanism of molecular mimicry or heterologous immunity following viral infections triggering autoimmunity. Apart from infections, other exogenous factors such as visible light or X-rays have been reported to incite autoimmunity. Case Report We report a case of histologically and serologically confirmed subacute lupus erythematosus (SCLE) following radiotherapy for breast cancer. Discussion The close temporal and spatial correlation between radiotherapy and onset of SCLE in this patient suggests that an autoimmune reaction may have been triggered locally by functionally altering the immune system and breaking self-tolerance.
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Affiliation(s)
- I Kolm
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
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Kocher C, Segerer S, Schleich A, Caduff R, Wyler L, Müller V, Beck B, Blum J, Kamarachev J, Mueller N. Skin lesions, malaise, and heart failure in a renal transplant recipient. Transpl Infect Dis 2012; 14:391-7. [DOI: 10.1111/j.1399-3062.2012.00731.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2011] [Revised: 11/03/2011] [Accepted: 12/21/2011] [Indexed: 11/28/2022]
Affiliation(s)
- C. Kocher
- Division of Infectious Diseases and Hospital Epidemiology; University Hospital of Zurich; Zurich; Switzerland
| | - S. Segerer
- Division of Nephrology; University Hospital of Zurich; Zurich; Switzerland
| | - A. Schleich
- Division of Nephrology; University Hospital of Zurich; Zurich; Switzerland
| | - R. Caduff
- Institute of Surgical Pathology; University Hospital of Zurich; Zurich; Switzerland
| | - L.G. Wyler
- Institute of Surgical Pathology; University Hospital of Zurich; Zurich; Switzerland
| | - V. Müller
- Medical Intensive Care Unit; University Hospital of Zurich; Zurich; Switzerland
| | - B. Beck
- Swiss Tropical and Public Health Institute SwissTPH; Basel; Switzerland
| | - J. Blum
- Swiss Tropical and Public Health Institute SwissTPH; Basel; Switzerland
| | - J. Kamarachev
- Institute of Dermatopathology; University Hospital of Zurich; Zurich; Switzerland
| | - N.J. Mueller
- Division of Infectious Diseases and Hospital Epidemiology; University Hospital of Zurich; Zurich; Switzerland
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Tresch S, Trueb RM, Kamarachev J, French LE, Hofbauer GFL. Disseminated herpes zoster mimicking rheumatoid vasculitis in a rheumatoid arthritis patient on etanercept. Dermatology 2010; 219:347-9. [PMID: 19648728 DOI: 10.1159/000232389] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2009] [Accepted: 04/21/2009] [Indexed: 11/19/2022] Open
Abstract
Tumor necrosis factor-alpha (TNFalpha)-blocking agents are immunomodulating agents introduced for treatment of a variety of chronic inflammatory disease conditions. Adverse effects include an increased incidence of infections. Clinically, these infections often have atypical presentations that may hamper prompt diagnosis. In our report of a patient on etanercept therapy for rheumatoid arthritis, the correct diagnosis was delayed because disseminated herpes zoster was clinically mimicking vasculitis. Initially assuming rheumatoid vasculitis, immunosuppression was increased, resulting in worsening of skin lesions. Only an extended work-up, including a skin biopsy and viral cultures, established the correct diagnosis. Management of varicella zoster virus (VZV) infection primarily focuses on early initiation of antiviral therapy to control VZV replication. Therapy with intravenous acyclovir followed by oral valacyclovir allowed complete resolution of acute skin changes. In immunosuppressed patients, the possibility of infection with atypical presentation must always be kept in mind, and that this might mimic other disease conditions. Broad differential diagnosis and an extended diagnostic workup help in establishing the correct diagnosis.
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Affiliation(s)
- S Tresch
- Dermatology Department, University Hospital Zürich, Züürich, Switzerland
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Marcollo Pini A, Kerl K, Kamarachev J, French L, Hofbauer G. Interstitial granulomatous drug reaction following intravenous ganciclovir. Br J Dermatol 2008; 158:1391-3. [DOI: 10.1111/j.1365-2133.2008.08560.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Pavlović MD, Kamarachev J, Adamic M. Primary cutaneous epidermotropic marginal zone B-cell lymphoma: a role for antihistamines in maintaining lymphoma cell growth? J Eur Acad Dermatol Venereol 2008; 22:1012-4. [PMID: 18503530 DOI: 10.1111/j.1468-3083.2007.02522.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Hofbauer GF, Kamarachev J, Kempf W, Burg G, Pestalozzi BC, Dummer R. A CD4+ CD56+ natural killer-like T-cell systemic lymphoma with haemorrhagic cutaneous manifestations. Br J Dermatol 2001; 144:432-4. [PMID: 11251598 DOI: 10.1046/j.1365-2133.2001.04052.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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