Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0278883 (metastatic melanoma)
 6,224 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Retroperitoneal fibrosis (RF) often presents with characteristic clinical and urographic findings that suggest the diagnosis. However, malignant adenopathy may mimic this appearance. CT examinations of 10 patients with medial deviation of the ureters suggesting retroperitoneal fibrosis were reviewed. Six had idiopathic RF, two had perianeurysmal fibrosis, and two had malignant retroperitoneal adenopathy. The CT findings in idiopathic RF included a homogeneous mass enveloping the ureters, aorta, and inferior vena cava. The aortic aneurysm was easily seen in both patients with perianeurysmal fibrosis. In one of the two patients with malignant retroperitoneal adenopathy, the CT findings mimicked idiopathic RF. In the other patient, the nodes involved with metastatic melanoma caused significant anterior displacement of the aorta and inferior vena cava. This marked anterior displacement of the great vessels is not seen in idiopathic RF, and may be useful in differentiating these entities.
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PMID:Retroperitoneal fibrosis: use of CT in distinguishing among possible causes. 348 10

Early detection of metastatic melanoma has become more important as newer and more effective therapeutic regimens are used. Between 1970 and 1980, 1,600 patients were treated at one institution for malignant melanoma. Of these, 260 (16.3%) developed thoracic metastasis. Satisfactory chest radiographs were available for analysis in 130 of 260 patients. The patterns of the intrathoracic metastasis include multiple pulmonary nodules (52 patients), solitary nodule (26), miliary pattern (two), mediastinal and/or hilar adenopathy (nine), pleural effusion (three), lytic bony lesions (one), extra-pleural mass (one), and combined lesions (36). Both the staging of melanoma and the radiographic pattern of thoracic metastasis seemed to prognosticate the survival rate of these patients. Miliary metastasis and bone destruction implied a grave prognosis. Patients with a solitary lung nodule had the best survival experience. Immunotherapy, chemotherapy, and surgery of selected distal metastases significantly improved the survival of most of these patients.
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PMID:Metastatic melanoma in the thorax: report of 130 patients. 678 36

Fine-needle aspiration (FNA) is an effective tool in evaluating the cause of lymphadenopathy. While the morphologic diagnosis of a reactive lymphoid proliferation is common in younger patients, this diagnosis should be made carefully in older patients (those over the age of 50 yr) in light of the facts that such purely reactive conditions occur much less frequently in this population, and that follow-up of these patients reveals a malignancy (usually lymphoma) in a significant number of cases. In this series, we identified 40 patients with a morphologic diagnosis of reactive lymphoid proliferation on FNA and obtained their follow-up information. Of 19 patients under the age of 50 yr, 5 underwent subsequent biopsies and only one revealed a definitive malignancy (5%). In contrast, 7 of 21 patients over the age of 50 yr underwent a subsequent biopsy, and 6 were found to have a malignancy (5 malignant lymphomas, 1 metastatic melanoma). The higher rate of positive follow-up (29%) in this age group supports previous suggestions that morphologically reactive (mixed) lymphoid proliferations be viewed with increased suspicion in the elderly patient, and that additional studies, such as flow cytometry, be performed when material is available.
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PMID:Follow-up of morphologically reactive lymphoid proliferations in fine-needle aspirates of elderly patients. 1100 66

We report a case of nodal nevus present in enlarged lymph nodes with changes of dermatopathic lymphadenopathy sampled by fine-needle aspiration (FNA) cytology prior to clinical evaluation of the patient. This lymph node pathology was established later by lymph node excisional biopsy, by which along with a skin biopsy the dermatopathic lymphadenopathy was tentatively attributed to early mycosis fungoides. The FNA revealed fairly atypical melanotic tissue from the dermatopathic lymphadenopathy along with nodules of uniform melanocytic nevoid cells, the presence of which in combination with the dermatopathic atypical tissue provided a tentative diagnosis of metastatic melanoma of unknown primary, with the diagnosis of nodal nevus presented as a less likely possibility. This is to our knowledge the first cytologic report on FNA of nodal nevus, which besides presenting cytologic findings of this entity highlights some of the problems related to providing an accurate diagnosis, if this exceptionally unusual pathologic entity is encountered in lymph nodes sampled for enlargement from pathologies unrelated to this entity. The subject of nevus changes in lymph nodes is briefly discussed.
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PMID:Nevus-cell aggregates in lymph nodes: fine-needle aspiration cytologic findings and resulting diagnostic difficulties. 1534 90

We report a case of axillary lymphadenopathy thirty years after a decorative tattoo clinically mimicking metastatic melanoma. The importance of relying on histological confirmation of metastatic disease before altering extent of surgery is discussed. The importance of recording presence of decorative tattoos is stressed.
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PMID:Tattoo pigment in an axillary lymph node simulating metastatic malignant melanoma. 1632 Nov 51

Vulvar extramammary Paget disease (EMPD) is an intraepithelial carcinoma not frequently seen in conjunction with other primary tumors. Nevertheless, we are presenting a collision between malignant nodular melanoma and EMPD in the vulva of a 78-year-old gravida 6, para 6 woman with a medical history of chronic lymphocytic leukemia. The patient presented with vulvar irritation and a pigmented vulvar mass; biopsy confirmed the diagnosis of malignant melanoma. Peripheral to the main mass, the vulva grossly seemed erythematous, and the perineum seemed white and thickened. Multiple radial biopsies were taken to determine the extent of involvement by malignant melanoma, and these biopsies revealed that the "irritated" areas surrounding the melanoma were EMPD. Subsequently, a radical vulvectomy was performed, the margins of which were clear of both neoplasms. Five months later, bilateral groin adenopathy was biopsy proven to be metastatic melanoma and chronic lymphocytic leukemia, and the patient died 8 months after the radical vulvectomy.
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PMID:Pagetoid lesions of the vulva: a collision between malignant melanoma and extramammary Paget disease. 1831 9

Patients with isolated axillary lymphadenopathy are often referred to rapid-access breast clinics for diagnostic evaluation. In the absence of a discernable breast primary, tissue diagnosis has conventionally been pursued using open biopsy. We aimed to assess the value of freehand needle core biopsy (FNCB) as an alternative to this. A prospective audit was conducted over 6 years from 2002 to 2008. Twenty-eight procedures were performed, all carried out under local anaesthesia in the outpatient setting. The majority of cases (10) revealed metastatic breast cancer. Other diagnoses included metastatic ovarian cancer (2), metastatic melanoma (3), lymphoma (4), silicone granuloma (1) and chronic lymphocytic leukemia (1). Seven patients had inconclusive histology necessitating further open biopsy. This revealed primary lymphoma in 6 cases and benign histology in one. FNCB thus avoided the need for diagnostic excision biopsy in 75% (21/28) patients. However, it was found to be less useful in diagnosing de-novo lymphoma.
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PMID:The role of freehand needle core biopsy in the diagnosis of isolated axillary lymphadenopathy. 1936 40

Monoclonal antibodies directed against the immune checkpoint protein cytotoxic T-lymphocyte antigen-4 (CTLA-4; CD152)-ipilimumab and tremelimumab-have been investigated in metastatic melanoma and other cancers and have shown promising results. Recently, ipilimumab was approved by the US Food and Drug Administration for the treatment of metastatic melanoma. We review the literature on managing the adverse effects and kinetics of tumor regression with ipilimumab and provide guidelines on their management. During treatment with these antibodies, a unique set of adverse effects may occur, called immune-related adverse events (irAEs). These include rashes, which may rarely progress to life-threatening toxic epidermal necrolysis, and colitis, characterized by a mild to moderate, but occasionally also severe and persistent diarrhea. Hypophysitis, hepatitis, pancreatitis, iridocyclitis, lymphadenopathy, neuropathies, and nephritis have also been reported with ipilimumab. Early recognition of irAEs and initiation of treatment are critical to reduce the risk of sequelae. Interestingly, irAEs correlated with treatment response in some studies. Unique kinetics of response have been observed with CTLA-4 blockade with at least four patterns: (1) response in baseline lesions by week 12, with no new lesions seen; (2) stable disease, followed by a slow, steady decline in total tumor burden; (3) regression of tumor after initial increase in total tumor burden; and (4) reduction in total tumor burden during or after the appearance of new lesion(s) after week 12. We provide a detailed description of irAEs and recommendations for practicing oncologists who are managing them, along with the unusual kinetics of response associated with ipilimumab therapy.
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PMID:Management of immune-related adverse events and kinetics of response with ipilimumab. 2261 89

PURPOSE.: Dorsal midbrain syndrome, which is characterized by upgaze paralysis, light-near dissociated pupils, eyelid retraction, and convergence retraction nystagmus, can be caused by compression, ischemia, inflammation, or injury to the dorsal midbrain. Although brain metastases are common in certain cancers, including melanoma, only 3 to 5% occur in the brain stem. We present a case of metastatic melanoma from an unknown primary that initially presented as dorsal midbrain syndrome. CASE REPORT.: After a prodrome of intermittent nonspecific visual symptoms, a 60-year-old male veteran presented with bilateral upgaze paralysis and convergence retraction nystagmus. A single hemorrhagic lesion in the midbrain was causative. An inguinal mass with associated lymphadenopathy was subsequently discovered, and the biopsy from this site revealed malignant melanoma. A primary lesion was never found. The patient underwent surgical resection of the groin lesion and stereotactic radiosurgery for the midbrain metastasis but passed away 6 months after his initial presentation. CONCLUSIONS.: The presentation of bilateral vertical gaze paralysis, especially in the company of convergence retraction nystagmus, light-near dissociated pupils, or eyelid retraction, should raise concern for midbrain pathology. Although metastases to the midbrain are rare, they carry a grave prognosis, especially if melanoma is the primary malignancy, and most treatment options are considered palliative.
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PMID:Metastatic melanoma from unknown primary presenting as dorsal midbrain syndrome. 2314 79

Monoclonal antibodies directed against immune checkpoint proteins, such as cytotoxic T-lymphocyte antigen-4 (CTLA-4) or programmed death-1 (PD-1), can boost endogenous immune responses directed against tumor cells. Recently, ipilimumab was approved by the U.S. Food and Drug Administration (FDA) for the treatment of metastatic melanoma, and the anti-PD-1 antibody BMS-936558 has shown promising results in patients with melanoma, non-small cell lung cancer, and renal cell cancer. During treatment with these antibodies, a unique set of toxicities occur called immune-related adverse events (irAEs). These irAEs may occur at any time during treatment and include colitis characterized by a mild to moderate but occasionally severe and persistent diarrhea. Hypophysitis, hepatitis, pancreatitis, iridocyclitis, lymphadenopathy, neuropathies, and nephritis have also been reported with ipilimumab, and a subset of those side effects has also been observed with BMS-936558. Patient and physician education as well as good patient-caretaker communication are keys to limiting the morbidity of irAEs. Early recognition of these irAEs and initiation of treatment are critical to reduce the risk of complications, since virtually all irAEs are reversible with the use of steroids and other immune suppressants. The onset of grade 3 to 4 irAEs correlated with treatment response in some ipilimumab studies. This article provides detailed description and recommendations for practicing oncologists to manage the common irAEs associated with antibodies against immune checkpoint blockade.
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PMID:Practical management of immune-related adverse events from immune checkpoint protein antibodies for the oncologist. 2445 30


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