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Rodriguez S, Sener U, Elmore K, Haque S, Suser S, Greenfield J, Donzelli M, DePass C, Pugh J, Porter J, Meeker N, Wells E, Marghoob A, Khakoo Y. RARE-10. Neurocutaneous melanocytosis-associated hydrocephalus: the MSK experience from 2001-2022. Neuro Oncol 2022. [PMCID: PMC9164832 DOI: 10.1093/neuonc/noac079.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE: We hypothesize that patients with neurocutaneous melanocytosis-associated melanoma and ventriculoperitoneal shunts are at risk of developing intraperitoneal spread of melanoma. BACKGROUND: Neurocutaneous melanocytosis, a rare condition characterized by excessive proliferation and deposition of melanocytes in the leptomeninges and brain parenchyma, typically occurs in children with large congenital melanocytic nevi and multiple smaller congenital nevi. These patients are at heightened risk for developing NRAS+ melanomas in the central nervous system, which in turn may lead to symptomatic hydrocephalus requiring cerebrospinal fluid diversion for symptom relief. METHODS: Retrospective single-institution study of patients with histologically or radiographically confirmed NCM evaluated at Memorial Sloan Kettering Cancer Center (MSKCC) from 2001-2022. RESULTS: Of the 47 patients with a diagnosis of NCM, 44 patients had symptomatic neurological complications. Eleven patients developed hydrocephalus, 10 had CNS melanoma, and required ventriculoperitoneal shunt placement. Nine of the 10 patients ultimately died of their disease. Three patients were diagnosed with intraperitoneal melanoma, though data are unavailable for the remaining eight. CONCLUSIONS: All (n=11) patients with NCM-associated CNS melanoma required VP shunts for symptomatic relief. Ten of these patients died within 4.3 years of VP shunt placement, with a range of 1 month to 13.5 years prior to succumbing to their disease. While the intraperitoneal pathology remains unknown for 7 of the cases, 3 had confirmed intraperitoneal melanoma, suggesting that VP shunts provided the conduit to CNS melanoma seeding of the peritoneum. Obtaining baseline abdominal imaging studies prior to VP shunt placement may be helpful in the follow-up of these patients.
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Affiliation(s)
| | | | | | - Sofia Haque
- Memorial Sloan Kettering Cancer Center, New York , NY , USA
- New York-Presbyterian: Weill Cornell Medical Center, New York , NY , USA
| | | | - Jeffrey Greenfield
- Memorial Sloan Kettering Cancer Center, New York , NY , USA
- New York-Presbyterian: Weill Cornell Medical Center, New York , NY , USA
| | - Maria Donzelli
- Memorial Sloan Kettering Cancer Center, New York , NY , USA
| | | | - John Pugh
- Albany Medical Center , Albany, NY , USA
| | | | - Nathan Meeker
- St. Luke's Children's Cancer Institute , Boise, Idaho , USA
| | | | | | - Yasmin Khakoo
- Memorial Sloan Kettering Cancer Center, New York , NY , USA
- New York-Presbyterian: Weill Cornell Medical Center, New York , NY , USA
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Sener U, Elmore K, Jayaseelan K, Porter J, Marghoob A, Rosenblum MK, Haque S, Khakoo Y. Neurocutaneous melanocytosis-associated malignant melanoma presenting with peritoneal seeding. Pediatr Dermatol 2021; 38:1298-1301. [PMID: 34463389 PMCID: PMC9429811 DOI: 10.1111/pde.14789] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Neurocutaneous melanocytosis (NCM) is characterized by melanocyte deposition in the leptomeninges and brain parenchyma, primarily occurring in children with large or giant congenital melanocytic nevi (LCMN) or multiple congenital melanocytic nevi. Patients with NCM may develop hydrocephalus and increased intracranial pressure, which can be managed with ventriculoperitoneal (VP) shunting. We present the case of a 16-month-old girl who developed peritoneal carcinomatosis and malignant ascites following VP shunting for hydrocephalus secondary to NCM to increase awareness of this rare, but serious, complication of cerebrospinal fluid diversion.
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Affiliation(s)
- Ugur Sener
- Department of Neurology, West Virginia University School of Medicine, Morgantown, WV, USA
| | - Kevin Elmore
- Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Joanne Porter
- Department of Pediatrics, Albany Medical College, Albany, NY, USA
| | - Ashfaq Marghoob
- Department of Dermatology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Marc K Rosenblum
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Sofia Haque
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Yasmin Khakoo
- Departments of Pediatrics and Neurology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Department of Pediatrics, Weill Cornell Medical College, New York, NY, USA
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Elmore K, Sener U, Ennin E, Suser S, Marghoob A, Haque S, Khakoo Y. NCOG-60. MALIGNANT MELANOMA IN NEUROCUTANEOUS MELANOCYTOSIS: A RETROSPECTIVE CASE SERIES (2000-2020). Neuro Oncol 2020. [DOI: 10.1093/neuonc/noaa215.598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Neurocutaneous melanocytosis (NCM) is a rare neurocutaneous syndrome which typically develops in children with large congenital melanocytic nevi (LCMN) and excessive melanocyte proliferation in the leptomeninges and brain parenchyma. Malignant melanoma develops in an estimated 2.3% of patients with LCMN and 40-60% of patients with NCM. NCM-associated melanomas frequently harbor NRAS mutations with no well-established role for targeted therapy. In a retrospective, single-institution study, we reviewed eleven patients with NCM-associated CNS melanoma evaluated at Memorial Sloan Kettering Cancer Center from June 2000 to January 2020. Five patients had previously identified focal melanocytosis prior to developing melanoma. In this subgroup, the median time from identification of focal melanocytosis to melanoma diagnosis was 80 months (range: 18-200). Median age at melanoma diagnosis was 9.9 years (range: 1.1-25.3). Presentation at the time of diagnosis with CNS melanoma included headache (45%), focal deficits (45%), and seizure (18%). Eight patients had hydrocephalus (73%). Five patients presented with a focal mass (45%) and six patients had focal or diffuse leptomeningeal disease without a mass (55%). Leptomeningeal spread eventually developed in all patients. Where molecular testing was available, three melanomas had NRAS mutations and none were associated with BRAF mutations. Seven patients were treated with cancer-directed therapy including temozolomide, trametinib, ipilimumab, and nivolumab, with each therapy being administered to two patients. Radiation therapy was used in three patients, including whole brain radiation therapy and stereotactic radiosurgery. Median survival from melanoma diagnosis was 9.1 months (range: 1-60.4). The longest surviving patient was initially diagnosed with cutaneous melanoma, surviving 60.4 months after diagnosis with cutaneous melanoma and 22.7 months after diagnosis with CNS melanoma. Prognosis remains guarded in patients with NCM-associated melanoma, and further investigation is warranted to identify effective management strategies.
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Affiliation(s)
- Kevin Elmore
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ugur Sener
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Elsie Ennin
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | | | - Sofia Haque
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Yasmin Khakoo
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Xu Q, Xing L, Xiong G, Elmore K, Min J. SU-E-I-41: Dictionary Learning Based Quantitative Reconstruction for Low-Dose Dual-Energy CT (DECT). Med Phys 2015. [DOI: 10.1118/1.4924038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Xu Q, Xing L, Xiong G, Elmore K, Min J. SU-E-I-39: Combining Conventional Tomographic Imaging Strategy and Interior Tomography for Low Dose Dual-Energy CT (DECT). Med Phys 2015. [DOI: 10.1118/1.4924036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Zhao W, Niu T, Xing L, Xiong G, Elmore K, Zhu J, Wang L, Min J. MO-FG-204-03: Using Edge-Preserving Algorithm for Significantly Improved Image-Domain Material Decomposition in Dual Energy CT. Med Phys 2015. [DOI: 10.1118/1.4925424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Manangan L, Elmore K, Lewis B, Pratt R, Armstrong L, Davison J, Santibanez S, Heetderks A, Robison V, Lee V, Navin T. Disparities in tuberculosis between Asian/Pacific Islanders and non-Hispanic Whites, United States, 1993-2006. Int J Tuberc Lung Dis 2009; 13:1077-1085. [PMID: 19723395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023] Open
Abstract
SETTING The United States (US) National Tuberculosis Surveillance System (NTSS), including 50 states, District of Columbia, and New York City. OBJECTIVE To examine disparities in characteristics and rates of Asian/Pacific Islander (API) and non-Hispanic White tuberculosis (TB) patients. DESIGN Descriptive analysis and logistic regression of selected 1993-2006 NTSS data. US Census Bureau Zip Code Tabulation Areas and geographic information system were used to compare API and non-Hispanic White TB patients by population density. RESULT Of 253,299 TB cases, 19.8% were APIs and 23.2% were Whites; 94.2% APIs and 11.9% Whites were foreign-born. Factors that were most often associated with APIs were being female, age 15-24 years, extra-pulmonary TB, and drug resistance. APIs were less likely than Whites to be human immunodeficiency virus (HIV) positive, homeless, substance abusers, or on directly observed therapy. From 1993 to 2006, the API TB case rate declined by 42.9% vs. 66.6% in Whites (P < 0.01). Being foreign-born was the strongest risk factor for TB, regardless of population densities, but APIs were more likely to have TB than foreign-born Whites at lower population densities. CONCLUSION Disparities in TB exist among US APIs and non-Hispanic Whites. TB program officials should allocate programs appropriately for foreign-born APIs in lower population density areas.
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Affiliation(s)
- L Manangan
- Division of Tuberculosis Elimination, National Center for HIV, Hepatitis, STD, and TB Prevention (NCHHSTP), Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA.
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Zhang R, Butterbaugh G, Liao J, Aguilar E, Rose M, Roques B, Thomson J, Elmore K, Reisin E. 52 SUB-CLINICAL IMFLAMMATION CONTRIBUTES TO THE EARLY DEVELOPMENT OF CARDIOVASCULAR DISEASE IN THE NON-HYPERENSIVE YOUNG HEALTHY PREFESSIONALS. J Investig Med 2005. [DOI: 10.2310/6650.2005.00006.51] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Elmore K, Thakur V. 211 INDADEQUACY OF CUFFED VENOUS CATHETERS IN HEMODIALYSIS SUBJECTS:. J Investig Med 2005. [DOI: 10.2310/6650.2005.00006.210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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