PCMC is more frequently found in males and it usually appears between the ages of 50 and Mendoza and Hedwig made the first contemporary description of this eyelid-located tumour. Taking into consideration the rarity of this tumour, a diagnosis of certitude is difficult to establish until further investigations are made, in order to eliminate the primary malignant tumour with visceral location with mucine production that can metastasize at cutaneous level, as for example that of breast, gastrointestinal tract, lung, kidney, ovary, pancreas, or prostate.
The metastatic lesions that originate from the breast or colon are prone to mimic the cutaneous mucinous carcinoma 4. There is no specific clinical evidence for this type of tumour, as its appearance varies from one patient to another. The first clinical impression is that of a cyst, basal cell carcinoma, keratoacantoma, nevus, apocrine hidrocystoma, another location primary tumour metastasis and in certain circumstances the clinical differentiation includes vascular lesions as those found in the Kaposi sarcoma 5.
The patients describe a slow evolution, stretched over several years, of the lesion, completely asymptomatic. Occasional, the very old tumours or the very aggressive ones papillomaviruses causing cancer evasion from host-cell control in early events in carcinogenesis invade the adjacent structures 6.
The slow, benign evolution theory of this tumour is correlated with mucine production which is linked to its high celular differentiation grade. Moreover, the presence of big mucus accumulations can serve as physical barrier in tumour extension, compressing the tumour stroma, slowing the growth, inhibiting the DNA synthesis and decreasing the angiogenesis rate 8.
Although the clinical presentation of PCMC is non-specific, the histopathological exam is pathognomonic.
ARCHIVES OF THE BALKAN MEDICAL UNION
Usually, the tumour is well delimitated, with small accumulations or tubules of epithelial cells which float in mucine.
Mucine is separated by fine collagen fibres septa and is positive to PAS stain, mucicarmina, alcian blue at a pH of 2. Mucine, same as sialomucine, was characterized as sialidase-labile.
The cells are small, basaloid, vacuolated with eosinophilic cytoplasm. The cellular pleomorfism and the 1. Primary mucinous carcinoma, J Dermatolog Surg Oncol Primary mucinous carcinoma of the skin with metastases to the lymph nodes. Am J Dermatopathol ; Carcinomas of sweat glands, report of 60 cases.
Arch Pathol Lab Med ; Smith CC Metastazing carcinoma of the sweat-glands. Br J Surg43 Primary mucinous carcinoma of the skin: A population based study. Int J Dermatol. Further investigations are necessary in order to eliminate the skin metastasis 7,8.
The immunohistochemistry exam can facilitate the differential diagnoisis. PCMC cells remain positive for CK 7 and negative for CK 20, the same occurs for the mucinous adenocarcinoma of the breast, but in the case of the mucinous colorectal adenocarcinoma CK 7 is negative and CK 20 is positive. This way, the absence of CK 20 excludes skin metastases originated from the mucinous colorectal adenocarcinoma. Another CK 7 positive prevenire il papilloma virus CK 20 negative tumours, as the adenocarcinoma of the lung or of the gallbladder, can also produce skin metastases.
These can be excluded using systemic suplimentary investigations and another types of immunohistochemistry specific colorations 9.
Universitatea de Medicină şi Farmacie Gr. Popa Iaşi, Disciplina de Histologie 2. The protein capsid L1 of HPV represents the major target of the cellular immune response in the cervical squamous intraepithelial lesions. The conventional smears and the cervical biopsies were Papanicolau and Hematoxylin-Eosin stained and evaluated for the immunoexpression of L1HPV protein.
Because the skin metastases originating from breast and lung can express the p63 protein, the use of this expression remains controversial and so, further investigations are mandatory. Quereshi et al. In a complex analysis of the skin metastasis, Brownstein et al. The treatment of PCMC imposes local surgical excision. Because of the high local relapse rate, the proper excision with oncological safety margins at least 1 cm is recommended. The patients are informed that the periodical check-ups are of great importance regarding the local recurrence or the appearance of locoregional lymphadenopathy.
Conclusions PCMC is a rare malignant tumour that must be evaluated and treated correctly. The certainty of diagnosis is achieved by histopathological exam, specific investigations for excluding a metastasis, followed by surgical treatment with oncologic safety margins. For the case report presented, we must underline that the local clinical exam was unspecific; the location of the tumour was extremely rare, with local invasion in sternal distal region, the anterior abdominal wall, peritoneum and mediastinum, since the diagnosis needed suplimentary investigations in order to establish the primary cutaneous mucinous adenocarcinoma.
Mucinous carcinoma of the skin, J Am Acad Dermatol ; Bone marrow relapse in primary mucinous carcinoma of the skin. Am J Clin Oncol ; Report of a case: primary mucinous carcinoma of the skin, Dermatol On J, 14 6 Primary mucinous carcinoma of the eyelid, a clinicopathologic and immunohistochemical study of anemie toamna cases and an update on recurrence rates; Arch Ophthalmol ; 9 Although belived to be uncommon and despite campaigns that advocate safe sun exposure habbits and early consult for suspicious lesions, the annual incidence is in continuous rise.
Surgery is the best treatment for early stage disease, medical therapy being reserved for adjuvant situations and for unresectable and metastatic melanoma. Chemotherapy offers poor response rates. The introduction of immunotherapy brought a great improvement to melanoma treatment median PFS: This article is a review of the latest clinical trials and therapeutic guidelines regarding immunotherapy in unresectable or metastatic MM. Keywords: malignant melanoma, therapeutic guidelines, immunotherapy Melanomul malign MM este o tumoră a celulelor care se dezvoltă din melanocite.
Deşi considerat ca având frecvenţă redusă şi în pofida campaniilor care militează pentru o expunere judicioasă la soare şi consult medical al leziunilor suspecte, incidenţa anuală este în continuă creştere. Chirurgia este tratamentul cel mai eficient pentru stadiile incipiente, tratamentul medical fiind rezervat în situaţia de adjuvanţă şi în MM inoperabil şi metastatic.
Chimioterapia oferă rate scăzute de răspuns. Introducerea imunoterapiei a adus îmbunătăţiri semnificative în tratamentul melanomului PFS mediu: 11,2 luni pentru tratament combinat şi a oferit unor pacienţi supravieţuire pe termen lung. Articolul este o recenzie a ultimelor studii clinice şi a ghidurilor terapeutice privind imunoterapia în MM nerezecabil sau metastatic.
Cuvinte-cheie: melanom malign, ghiduri terapeutice, imunoterapie Introduction Classic agents like dacarbazine DTICchemotherapy combinations like carboplatin and paclitaxel or newer agents like temozolomide yield only modest response rates and have very little influence on overall survival OS.
The turning point for melanoma treatment especially for BRAF mutation negative patients was first reached in with the introduction of immunotherapy - ipilimumab IPIbut the true improvement was yet to come: ina combination of ipilimumab and nivolumab, which in previously untreated patients boosted a median PFS papillomaviruses causing cancer evasion from host-cell control in early events in carcinogenesis over 11 months, something unseen with any other therapy till that moment.
Advantages for immunotherapy are that searching for tumor mutations is less critical and that a number 14 of patients achieve a long term, durable response long term survivors. Ipilimumab Ipilimumab is a CTLA-4 blocker anti-cytotoxic T-lymphocyte associated protein 4 approved for unresectable or metastatic melanoma. It is a humanized antibody directed at a down-regulatory receptor on activated T-cells 1. The mechanism of action is by inhibiting T cell inactivation and permitting their specific cytotoxic effect against melanoma cells.
There have been reported improvements in survival in patients with metastatic melanoma treated with Ipilimumab. In a phase 3 study by Hodi et al.
View in PDF Number of views: 2 Nowadays, more and more evidence points out to the interrelationship between intestinal microbiota and cardiovascular diseases. Gut microbiota is composed of a large number of microorganisms that live in the human gut and are involved in many physiological processes. Changes in the composition and activity of intestinal microbiota may lead or may accelerate the evolution of some cardiovascular diseases. Alterations in the composition of gut microbiota will induce dysbiosis, causing inflammation and initiating the development of cardiovascular diseases.
The median overall survival was 10 months on the arm receiving ipilimumab plus gp, compared with 6. In another phase 3 study, ipilimumab and dacarbazine were compared to dacarbazine and placebo: the survival was improved with 2 months 11 vs. The most common side effects of IPI in this study were rash, diarrhea, fatigue, itching, headache, weight loss and nausea. It can also cause autoimmune disease in the digestive system, liver, skin, nervous system, hormone producing glands.
It should be avoided by pregnant women. Most immune AE were developed in 12 weeks of initial administration, and they typically passed in weeks. Most AE were managed keeping patients under observation and with corticosteroids; only 5 patients required infliximab, a TNF tumor necrosis factor inhibitor for gastrointestinal AE ulcerative colitiswith very good response and recovery 4,5. Comparing immunotherapies with chemotherapy, we can observe that the pattern of response is quite different: while results after chemotherapy may be seen in a few weeks, in immunotherapies we can experience an initial pseudo progression of the targeted lesions, which can last up to weeks, a moment from when the response is observed.
The phenomenon seems to be explained by immune cells that infiltrate into the tumor. Their interaction inhibits immune response and diminishes T cell antitoxic activity. This process is necessary for keeping immune response in normal limits and prevents normal cells from suffering harm during chronic inflammation.
Journal archive. Articles: ARCHIVES OF THE BALKAN MEDICAL UNION
The tumor can bypass T cell mediated cytotoxicity by expressing PD-L1 on tumor surface or on tumor infiltrating immune cells, avoiding immune mediated killing of the tumor cell.
Progressionfree survival rates for the pembrolizumab papillomaviruses causing cancer evasion from host-cell control in early events in carcinogenesis were The most common adverse events reported included fatigue, pruritus, rash, constipation, nausea, diarrhea, and decreased appetite. The most serious risks of pembrolizumab are immune-mediated adverse reactions, including pneumonitis, colitis, hepatitis, endocrinopathies, and nephritis. Nivolumab is another PD-1 inhibitor which went through the same steps of approval as pembrolizumab.
Registration was done based on a study of patients with unresectable or metastatic MM that have progressed after IPI. Nivolumab is associated with immune-mediated: pneumonitis, colitis, hepatitis, endocrinopathies, nephritis and renal dysfunction, rash, encephalitis, infusion reactions, and embryofetal toxicity.
Nivolumab and ipilimumab combination The approval of the combination regimen of nivolumab plus ipilimumab in previously untreated patients Figure 2.
Approval was based on results from a phase 2 study - CheckMate study. Median PFS was 8. It is a genetically modified, live attenuated herpes simplex type I virus programmed to replicate within tumors and produce the immune stimulatory protein granulocyte-macrophage colony-stimulating factor GMCSF. It is indicated for the local treatment of unresectable cutaneous, subcutaneous, and nodal lesions in patients with papillomaviruses causing cancer evasion from host-cell control in early events in carcinogenesis recurrence after initial surgery.
It is admi- 16 1. Recent advances using anti-CTLA-4 for the treatment of melanoma.
Oncolog-Hematolog Nr. 35 (2/) by Versa Media - Issuu
Cancer J. Improved survival with ipilimumab in patients with metastatic melanoma. N Engl J Med. Ipilimumab plus dacarbazine for previously untreated metastatic melanoma. Boggs W. Immune-related problems due to ipilimumab emerge early, resolve with discontinuation. Medscape Medical News. February 12, Accessed: March 4, Patterns of onset and resolution of immune-related adverse events of special interest with ipilimumab: Detailed safety analysis from a phase 3 trial in patients with advanced melanoma.
US Food and Drug Administration. FDA approves Keytruda for advanced melanoma: first PD-1 blocking drug to receive agency approval [press release].
September 4, Accessed: September 9, The registration study had patients, of which patients treated with talimogene laherparepvec were compared to patients treated with GM-CSF. Of the patients with durable response, The median time to response was 4. ORR rate was also higher with talimogene laherparepvec In all, 32 The median time to treatment failure was 8. Median OS was Although these treatments come with a high cost, the invaluable lessons learned from developing and use of these new therapies opens a new perspective on cancer and immunology, enhancing our knowledge and understanding of the disease, and hopefully bringing in time new and more accessible drugs.
Nivolumab versus chemotherapy in patients with advanced melanoma who progressed after anti-CTLA-4 treatment CheckMate : a randomised, controlled, open-label, phase 3 trial. Lancet Oncol. Keytruda Pembrolizumab prescribing information, Opdivo Nivolumab prescribing information, Nivolumab and ipilimumab versus ipilimumab in untreated melanoma. Nelson, R. October 27, J Clin Oncol. Spain L, Larkin J. Combination immune checkpoint blockade with ipilimumab and nivolumab in the management of advanced melanoma.
Expert Opin Biol Ther. Medscape Reference — Malignant melanoma treatment, accessed May The virus infects basal epithelial cells of stratified squamous epithelium.
Number 3, 2019
HPV E6 and E7 oncoproteins are the critical molecules in the process of malignant tumour formation. Interacting with various cellular proteins, E6 and E7 influence fundamental cellular functions like cell cycle regulation, telomere maintenance, susceptibility to apoptosis, intercellular adhesion and regulation of immune responses.
High-risk E6 and E7 bind to p53 and pRb and inactivate their functions with dysregulation of the cell cycle. Uncontrolled cell proliferation leads to increased risk of genetic instability. Usually, it takes decades for cancer to develop. This review papillomaviruses causing cancer evasion from host-cell control in early events in carcinogenesis the main mechanisms of HPV genome in the carcinogenesis of the uterine cervix.