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Hallier A, Callier P, Sauge J, Cristofari S, Lombardo GAG, Aubriot-Lorton MH, Stivala A. Novel role of fluorescent in situ hybridization technique (FISH) in recommended surgical margins of dermatofibrosarcoma protuberans: A preliminary study. ANN CHIR PLAST ESTH 2024; 69:124-130. [PMID: 37652836 DOI: 10.1016/j.anplas.2023.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 08/17/2023] [Accepted: 08/18/2023] [Indexed: 09/02/2023]
Abstract
BACKGROUND Dermatofibrosarcoma protuberans (DFSP) is a rare skin tumor. There is no standard recommendation for its surgical management. The currently used histological analysis are HES (hematoxylin eosin saffron) staining and immunohistochemistry for CD34 expression in particular cases. Fluorescent in situ hybridization (FISH) technique is only used to qualify the DFSP as translocated or non-translocated and is not used as a diagnostic method. The aim of our study was to determine by FISH (as a diagnostic method) whether cancerous cells that could not be identified through HES staining±immunohistochemistry were present at the two-centimeter margins that were found to be tumor-free. METHODS Samples from patients who underwent surgery between 2010 and 2018 were collected. Intralesional and peripheral (at 2cm margins) paraffin slides were included. An average of 7.4 slides per specimen was analyzed. Firstly, the preselected slides were reread by a senior pathologist to confirm the absence of microscopic findings of DFSP at 2cm margins. Secondly a FISH analysis was used as a quantitative diagnostic approach, in order to find the t(17;22) translocation. RESULTS Among the seven specimens that included 2cm margins, two samples presented one or more translocations, which were not visible in standard morphology assessments at two centimeters tumor-free margins. CONCLUSIONS FISH analysis can have a new role in defining tumor-free margins. This would reduce the incidence of disease recurrence after resection and improve the post-operative complementary care.
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Affiliation(s)
- A Hallier
- Department of Maxillofacial, Plastic, Reconstructive and Esthetic Surgery, Dijon University Hospital, Dijon, France
| | - P Callier
- Department of Human Genetics, Dijon University Hospital, Dijon, France
| | - J Sauge
- Department of Pathology, Dijon University Hospital, Dijon, France
| | - S Cristofari
- Sorbonne University, 21, rue de l'École-de-Médecine, 75006 Paris, France
| | - G A G Lombardo
- Azienda Ospedaliera Cannizzaro, Burn & Plastic Surgery, Via Messina, 829 Catania, Italy; Università Unikore di Enna, Piazza dell'Università, 94100 Enna EN, Italy.
| | | | - A Stivala
- Department of Maxillofacial, Plastic, Reconstructive and Esthetic Surgery, Dijon University Hospital, Dijon, France; Plastic, Reconstructive and Aesthetic Surgery, Centre Hospitalier de Mâcon, 350, boulevard Louis-Escande, 71000 Mâcon, France
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Tolat A, Kalwaniya DS, Sharma A, Kumar D, Rana S, Ahluwalia C. A Detailed Review of Surgical Management of Uncommon Cutaneous Disorders. Cureus 2023; 15:e36763. [PMID: 37123679 PMCID: PMC10132855 DOI: 10.7759/cureus.36763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/27/2023] [Indexed: 03/29/2023] Open
Abstract
A variety of cutaneous disorders can present to the general surgeon either directly or by referral for surgical intervention. Some conditions are commonly seen and operated on by general surgeons which include lipoma, epidermoid cyst, etc. On the other hand, some are uncommon conditions like dermatofibrosarcoma protuberans and chondroid syringoma which require a high index of suspicion to diagnose. Most general surgeons are not familiar with the latest guidelines to treat such uncommon conditions. In this article, we provide a review of uncommon cutaneous disorders requiring surgical intervention that were encountered at our high-volume tertiary care center and a discussion about their etiology, presentation, diagnosis, management and follow-up with one case report of each condition. The objective of this article is to familiarize the general surgeon with these cutaneous disorders which though uncommon, will present in their practice at some point.
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Rasheed AA, Barwad A, Dhamija E, Garg R, Pandey R, Shamim SA, Arun Raj ST, Rastogi S. Advanced dermatofibrosarcoma protuberans: an updated analysis of cases from an Indian sarcoma clinic. Future Sci OA 2021; 7:FSO743. [PMID: 34737884 PMCID: PMC8558865 DOI: 10.2144/fsoa-2020-0198] [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: 11/18/2020] [Accepted: 06/14/2021] [Indexed: 02/07/2023] Open
Abstract
AIM Dermatofibrosarcoma protuberans (DFSP) accounts for less than 2% of all soft-tissue sarcomas. PATIENTS & METHODS We retrospectively reviewed our database for patients with locally advanced or metastatic DFSP who had presented to our clinic between January 2016 and January 2020. RESULTS We identified a total of 14 patients, of whom ten had sarcomatous transformation. Eleven cases had metastatic disease and three were locally advanced. The initial partial response rate to first-line imatinib was 76.9% and the overall median progression-free survival on imatinib was 15 months. CONCLUSION We had a high proportion of patients with sarcomatous transformation, in contrast to their relative rarity in the West. While most patients had initial good responses to imatinib, second-line therapies were not as effective.
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Affiliation(s)
- Azgar A Rasheed
- Department of Medical Oncology, BRA-IRCH, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Adarsh Barwad
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Ekta Dhamija
- Department of Radiodiagnosis, BRA-IRCH, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Rakesh Garg
- Department of Onco-Anaesthesia & Palliative Medicine, BRA-IRCH, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Rambha Pandey
- Department of Radiation Oncology, BRA-IRCH, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Shamim A Shamim
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Sreedharan T Arun Raj
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Sameer Rastogi
- Department of Medical Oncology, BRA-IRCH, All India Institute of Medical Sciences, New Delhi, 110029, India
- Author for correspondence:
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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] [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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Muhammed A, Elnakib E, Nady M. Dermatofibrosarcoma of The Breast - Case Report and Review of Literature. Eur J Breast Health 2018; 14:234-237. [PMID: 30288499 DOI: 10.5152/ejbh.2018.3994] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Accepted: 04/11/2018] [Indexed: 11/22/2022]
Abstract
Dermatofibrosarcoma protuberans is a rare form of soft tissue sarcoma that tends to invade and recur locally. The most common site of this disease is head, neck and extremities; however, the involvement of the breast has been reported. We present a case with a dermatofibrosarcoma of the breast that is composed of low-grade spindle cells which are positive for CD43. She was treated by wide surgical excision followed by adjuvant external beam irradiation at a dose of 60 Gray. After a follow-up of 24 months, no local-regional or distant recurrence was detected.
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Affiliation(s)
- Amr Muhammed
- Department of Clinical Oncology and Nuclear Medicine, Sohag University Hospital, Sohag, Egypt
| | - Esraa Elnakib
- Department of Clinical Oncology and Nuclear Medicine, Sohag University Hospital, Sohag, Egypt
| | - Mahmoud Nady
- Department of Clinical Oncology and Nuclear Medicine, Sohag University Hospital, Sohag, Egypt
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6
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Cirillo F, Buononato M, Lima G, Cafaro I, Alquati P. Clinical Experience on Eight Cases of Merkel Cell Carcinoma. TUMORI JOURNAL 2018; 89:146-51. [PMID: 12841661 DOI: 10.1177/030089160308900208] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Merkel cell carcinoma is a rare neuroendocrine neoplasm of the skin. The tumor most frequently affects elderly patients, with a preference for the head and neck. Eight patients affected by Merkel cell carcinoma have been observed at the General Surgery Unit II of the “Istituti Ospitalieri” hospital in Cremona, each in different stages of the disease; 75% of the cases involved the extremities, and in nearly all of the cases the tumor was nodular in appearance, with an average diameter of 2.2 cm. In 2 cases, the tumor was associated with rheumatoid arthritis, suggesting a dependency on the part of the neoplasm on the immune disorder and on steroid treatment. The available data confirm that in stage I of the disease, surgical treatment should be associated with radiotherapy in order to control the development of local relapses or metastases over time. In this stage, we observed a survival of 34 months (range, 24-48). In stages II and III, survival time falls, with very short duration of responses and poor quality of life as a result of the administration of cytotoxic molecules. Bearing in mind that any local relapse tends to appear within 12 months of the removal of the primitive tumor, that lymph node metastases appear in almost half of the patients, and that metastases over time are manifested in over a third of patients, it is essential to adopt a treatment capable of balancing the demand for longer remissions with a better quality of life. In this situation, we observed that treatment with somatostatin analogues achieves interesting responses without side effects, which suggests a close biological relationship between the tumor and somatostatin and that making a careful assessment of the prognostic factors of the disease can guarantee a correct therapeutic choice.
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Affiliation(s)
- Fernando Cirillo
- Department of General Surgery, Azienda Ospedaliera Istituti Ospitalieri, Cremona, Italy.
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Incidence and Clinical Features of Rare Cutaneous Malignancies in Olmsted County, Minnesota, 2000 to 2010. Dermatol Surg 2017; 43:116-124. [PMID: 28027201 DOI: 10.1097/dss.0000000000000936] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The incidence of rare cutaneous malignancies is unknown. Current estimates of rare cutaneous malignancy incidences are based on broad epidemiologic data or single institution experiences, not population-based data. OBJECTIVE To determine the incidence of several rare nonmelanoma skin cancers. MATERIALS AND METHODS The authors conducted a retrospective chart review of a population-based cohort between the years 2000 and 2010. Residents of Olmsted County, Minnesota, who were diagnosed with a biopsy-proven nonmelanoma skin cancer-excluding basal cell carcinoma and squamous cell carcinoma-were included in this study. The primary outcome was tumor incidence. Additionally, the authors extracted patient demographics, tumor characteristics, treatment modalities, and outcomes. RESULTS The age-adjusted and sex-adjusted incidences per 100,000 persons of multiple rare cutaneous malignancies were: atypical fibroxanthoma (1.8), sebaceous carcinoma (0.8), dermatofibrosarcoma protuberans (0.4), microcystic adnexal carcinoma (0.7), eccrine carcinoma (0.4), eccrine porocarcinoma (0.2), and leiomyosarcoma (0.2). CONCLUSION The authors report population-based incidences and clinical characteristics for these rare cutaneous malignancies. The immune status and smoking status of patients and the treatment and outcomes of these tumors are reported. Additional studies in a broader population are needed to further define the epidemiology and outcomes of these malignancies.
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Sung TH, Tam AC, Khoo JL. Dermatofibrosarcoma Protuberans: A comprehensive review on the spectrum of clinico-radiological presentations. J Med Imaging Radiat Oncol 2016; 61:9-17. [PMID: 27753236 DOI: 10.1111/1754-9485.12549] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2016] [Accepted: 09/11/2016] [Indexed: 11/27/2022]
Abstract
Dermatofibrosarcoma Protuberans (DFSP) is a rare malignant soft-tissue neoplasm which is often misdiagnosed due to its indolent clinical course and non-specific radiological appearances. An observation case series was conducted with retrospective review of clinical and radiological data of DFSP patients presenting to a major tertiary hospital in Hong Kong for radiological assessment between November 2006 and February 2016. Seven patients with confirmed histological diagnosis of DFSP were included. Tumour sizes at presentation ranged from 1 to 5 cm, most commonly (n = 6) occurred over chest wall and abdominal wall. History of previous local trauma or surgery was identified in the majority of cases (n = 4). There was poor correlation between pre-imaging clinical diagnoses and pathological diagnoses. Local recurrence and tumour de-differentiation with sarcomatous changes occurred in the minority of cases (n = 2). A common radiological 'claw' sign at the lesion/skin interface formed by elongated appendages of the tumour superficially was appreciated in most cases (n = 6). A history of previous local trauma or surgery serves as a possible etiological factor for the development of DFSP. High clinical suspicion for the entity is essential in its detection and differentiation from simple wound complications and local recurrence of other benign lesions. The radiological 'claw' sign at the lesion/skin interface might serve as a tell-tale sign for cutaneous tumour involvement. A comprehensive analysis of imaging findings in conjunction with individual clinical presentations is the key to accurate diagnoses and proper management.
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Affiliation(s)
- Tony Ht Sung
- Department of Radiology, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong
| | - Annie Cw Tam
- Department of Radiology, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong
| | - Jennifer Ls Khoo
- Department of Radiology, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong
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9
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[Tumorogenesis and skin tumours in the elderly]. Hautarzt 2016; 67:132-9. [PMID: 26787292 DOI: 10.1007/s00105-015-3759-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
More than 1.5 million people were diagnosed with skin cancer in 2012 in Germany-of which 318,000 were malignant melanoma. The number of malignant skin tumours has increased by 60% since 2005. Epithelial skin cancers are even more common. Since 2012, 1.3 million diagnoses have been documented. This incidence represents an increase of 79% within 7 years. The number of skin cancer patients treated in German hospitals has also increased. In 2014, 99,613 patients were treated as inpatients with the diagnosis of skin cancer; in 2000 there were 57,147 patients. This was the largest growth rate among all cancer treatments in hospitalised patients. The continuously changing age pyramid leads to an expected further growth of the incidence of skin tumours. In parallel the development of molecular knowledge in tumorigenesis is also rapid. A series of cell-specific mutations have been described in recent years for various skin tumours. Mutations are found mainly in genes engaging their translation products at key positions in regulatory cell metabolism or cell division. These include oncogenes, which have greatly increased activity due to targeted mutations or tumor suppressor genes and act under physiological conditions as negative regulators that are inactivated by mutations. These findings have led to the development of a series of new promising compounds for the treatment of skin tumours.
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10
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Quiroz-Sandoval OA, Cuellar-Hubbe M, Lino-Silva LS, Salcedo-Hernández RA, López-Basave HN, Padilla-Rosciano AE, León-Takahashi AM, Herrera-Gómez Á. Primary retroperitoneal Merkel cell carcinoma: Case report and literature review. Int J Surg Case Rep 2015; 19:21-4. [PMID: 26708276 PMCID: PMC4756087 DOI: 10.1016/j.ijscr.2015.12.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Revised: 12/03/2015] [Accepted: 12/04/2015] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND Merkel cell carcinoma (MCC) is an aggressive cutaneous neuroendocrine carcinoma that affects elderly patients and typically arises in sun-exposed skin. The disease is very rare and only few cases present with no apparent skin lesion. In the retroperitoneum there are only two cases reported in the literature. CASE PRESENTATION We report a case of a 54-year-old Mexican male with MCC, which presented as a large retroperitoneal mass. Pathological and immunohistochemical analysis of the transabdominal CT-guided biopsy specimen revealed a MCC. The patient underwent preoperative chemotherapy followed by a laparotomy and the mass was successfully excised. DISCUSSION There are two possible explanations for what occurred in our patient. The most plausible theory is the retroperitoneal mass could be a massively enlarged lymph node where precursor cells became neoplastic. This would be consistent with a presumptive diagnosis of primary nodal disease. Moreover, metastasis to the retroperitoneal lymph nodes has been reported as relatively common when compared to other sites such as liver, bone, brain and skin. The less probable theory is the non-described "regression" phenomena of a cutaneous MCC, but we are not found a primary skin lesion. CONCLUSION Preoperative chemotherapy and excision of the primary tumor is the surgical treatment of choice for retroperitoneal MCC. We propose that further studies are needed to elucidate the true efficacy of chemotherapy in conventional and unconventional patients with MCC.
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Affiliation(s)
| | - Mario Cuellar-Hubbe
- Surgical Department of Bone and Soft Tissue Sarcomas, National Cancer Institute, Mexico City, Mexico
| | - Leonardo S Lino-Silva
- Anatomic Pathology Department of Gastrointestinal Tumors, National Cancer Institute, Mexico City, Mexico.
| | | | - Horacio N López-Basave
- Surgical Department of Gastrointestinal Tumors, National Cancer Institute, Mexico City, Mexico
| | | | | | - Ángel Herrera-Gómez
- Surgical Department of Gastrointestinal Tumors, National Cancer Institute, Mexico City, Mexico
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11
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Zhou QY, Wang YL, Li X, Shen XY, Li KJ, Zheng J, Yu YQ. Metabolomics investigation of cutaneous T cell lymphoma based on UHPLC-QTOF/MS. Asian Pac J Cancer Prev 2015; 15:5417-21. [PMID: 25041011 DOI: 10.7314/apjcp.2014.15.13.5417] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES The identification of cutaneous T cell lymphoma (CTCL) biomarkers may serve as a predictor of disease progression and treatment response. The aim of this study was to map potential biomarkers in CTCL plasma. DESIGN AND METHODS Plasma metabolic perturbations between CTCL cases and healthy individuals were investigated using metabolomics and ultrahigh performance liquid chromatography–quadrupole time-of-flight mass spectrometry (UHPLC-QTOF/MS). RESULTS Principal component analysis (PCA) of the spectra showed clear metabolic changes between the two groups. Thirty six potential biomarkers associated with CTCL were found. CONCLUSIONS Based on PCA, several biomarkers were determined and further identified by LC/MS/MS analysis. All of these could be potential early markers of CTCL. In addition, we established that heparin as anticoagulant has better pre-treatment results than EDTA with the UHPLC-QTOF/MS approach.
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Affiliation(s)
- Qing-Yuan Zhou
- School of Pharmacy, Fudan University, Shanghai, China E-mail :
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12
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Zheng Z, Piao J, Lee JH, Kim SE, Kim SC, Chung KY, Roh MR. Dermatofibrosarcoma protuberans: a study of clinical, pathologic, genetic, and therapeutic features in Korean patients. Yonsei Med J 2015; 56:440-6. [PMID: 25683993 PMCID: PMC4329356 DOI: 10.3349/ymj.2015.56.2.440] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
PURPOSE Dermatofibrosarcoma protuberans (DFSP) carries a translocation resulting in the collagen type I alpha 1 (COL1A1)-platelet-derived growth factor beta (PDGFB) fusion gene, which is responsible for PDGFB activation. The purpose of this study is to evaluate the clinicopathological, genetic, and therapeutic features of DFSP in Korean patients. MATERIALS AND METHODS Clinicopathological features of 37 patients with DFSP were reviewed. Multiplex reverse transcriptase-polymerase chain reaction (PCR) was carried out in 16 patients using formalin-fixed, paraffin-embedded tissues and specific primers for COL1A1 and PDGFB. RESULTS The mean age of 37 patients was 37.4 years old. The most common tumor location was the trunk. All patients were treated primarily with surgery: 34 (91.7%) cases with Mohs micrographic surgery (MMS) and 3 (8.3%) cases with wide local excision. The median follow-up time was 33.7 months. Two patients, one in each treatment group, demonstrated local recurrence during the follow-up period. The COL1A1-PDGFB fusion gene was expressed in 14 (87.5%) cases, demonstrated by reverse transcriptase PCR analysis. No association was found among the different COL1A1-PDGFB fusion transcripts, the various histological subtypes and clinical features. CONCLUSION Our results support the effectiveness of MMS in treating DFSP. The COL1A1-PDGFB fusion transcript was observed in 87.5% of patients. Therefore, COL1A1-PDGFB is a useful and accurate tool in diagnosing DFSP in Koreans.
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Affiliation(s)
- Zhenlong Zheng
- Department of Dermatology, Severance Hospital, Seoul, Korea.; Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, Korea.; Department of Dermatology, Yanbian University Hospital, Yanbian, China
| | - Junjei Piao
- Department of Dermatology, Severance Hospital, Seoul, Korea.; Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, Korea.; Department of Dermatology, Yanbian University Hospital, Yanbian, China
| | - Ji-Hye Lee
- Department of Dermatology, Gangnam Severance Hospital, Seoul, Korea.; Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Song-Ee Kim
- Department of Dermatology, Gangnam Severance Hospital, Seoul, Korea
| | - Soo-Chan Kim
- Department of Dermatology, Gangnam Severance Hospital, Seoul, Korea.; Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Kee Yang Chung
- Department of Dermatology, Severance Hospital, Seoul, Korea.; Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Mi Ryung Roh
- Department of Dermatology, Gangnam Severance Hospital, Seoul, Korea.; Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, Korea.
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13
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Valdivielso-Ramos M, Torrelo A, Campos M, Feito M, Gamo R, Rodriguez-Peralto JL. Pediatric dermatofibrosarcoma protuberans in Madrid, Spain: multi-institutional outcomes. Pediatr Dermatol 2014; 31:676-82. [PMID: 25424208 DOI: 10.1111/pde.12371] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Little is known about the incidence and management of dermatofibrosarcoma protuberans (DFSP) in children. We conducted a retrospective review of all patients younger than 18 years of age treated for DFSP over a period of 11 years (2000-2011) in Madrid, Spain. The sample consisted of 13 children. The average annual incidence of DFSP in the pediatric population corresponded to 1.02 cases per million person-years (95% confidence interval 0.55, 1.73). Sites of involvement were diverse, with 15.3% of tumors found in acral locations. The median tumor size was 3.5 cm × 3 cm and the median time from apparent onset to diagnosis was 36 months. Histopathologic examination revealed conventional (77.0%), pigmented (15.4%), and myxoid (7.6%) variants. The mitotic index was consistently <5 per 10 high-power fields. All lesions were removed using surgical excision. One patient developed a local recurrence because of initial affected margins; none developed metastases. The median duration of clinical follow-up was 70.5 months. This study estimated the average annual incidence rate of DFSP in a population of patients younger than 18 years and reviewed the experience of several hospitals in the management of this tumor.
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14
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Jiang JQ, Huang Z, Wang LH, Shen SDI, Lu H. Dermatofibrosarcoma protuberans of the breast: A case report. Oncol Lett 2014; 8:1202-1204. [PMID: 25120687 PMCID: PMC4114647 DOI: 10.3892/ol.2014.2291] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2013] [Accepted: 04/29/2014] [Indexed: 11/30/2022] Open
Abstract
Dermatofibrosarcoma protuberans (DFSP) is a rare, metastasizing tumor of the deep dermis and subcutaneous tissue. While it frequently occurs in the trunk and extremities, breast involvement has rarely been reported. In the present case, imaging and pathological technologies were used to detect DFSP of the breast. Surgical excision with wide margins (>3 cm) and pathology revealed spindle cells arranged in storiform patterns and short fascicles which were crucially CD34-positive, enabling a definitive diagnosis prior to surgery.
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Affiliation(s)
- Jin-Qun Jiang
- Department of Clinical Laboratory, Yuebei People's Hospital, Shaoguan, Guangdong 512026, P.R. China
| | - Zhan Huang
- Department of Breast Surgery, Yuebei People's Hospital, Shaoguan, Guangdong 512026, P.R. China
| | - Lin-Hui Wang
- Department of Pathology, Yuebei People's Hospital, Shaoguan, Guangdong 512026, P.R. China
| | - San-DI Shen
- Department of Breast Surgery, Yuebei People's Hospital, Shaoguan, Guangdong 512026, P.R. China
| | - Hai Lu
- Department of Breast Surgery, Yuebei People's Hospital, Shaoguan, Guangdong 512026, P.R. China
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15
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Abstract
OBJECTIVE To evaluate the potential association between occupational exposure to chlorinated and petroleum solvents and mycosis fungoides (MF). METHODS A questionnaire on lifetime job history was administered to 100 patients diagnosed with MF and 2846 controls. Odds ratios (ORs) were calculated as the measure of the association between exposure to each specific solvent and MF. RESULTS In the total sample and in men, cases and controls did not differ in relation to exposure to any of the solvents studied. In women, an association with MF was seen for the highest level of estimated exposure to perchloroethylene (OR = 11.38; 95% confidence interval: 1.04 to 124.85) and for exposure less than the median to kerosene/fuel/gasoil (OR = 8.53; 95% confidence interval: 1.11 to 65.62). CONCLUSIONS These results do not provide conclusive evidence that exposure to solvents may increase risk of MF because they were not found in men.
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Abstract
Over the past two decades, advances in the fields of cancer genetics and molecular biology have elucidated molecular pathways that cause numerous cutaneous malignancies. This in turn has spurred the rational design of molecularly targeted therapies. In this review, we discuss the molecular pathways critical to the development of nonmelanoma skin cancers and the novel pharmacologic agents that target them. Included is a review of vismodegib for basal cell carcinoma, cetuximab for squamous cell carcinomas, imatinib for dermatofibrosarcoma protuberans, and sirolimus for Kaposi's sarcoma.
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Affiliation(s)
- Lucinda S Liu
- Department of Dermatology, Yale School of Medicine, New Haven, CT 06520-8059, USA
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17
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Recurrent Dermatofibrosarcoma Protuberans With Pulmonary Metastases Presenting Twelve Years After Initial Diagnosis. Clin Nucl Med 2014; 39:77-8. [DOI: 10.1097/rlu.0b013e318279f28e] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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18
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Llombart B, Serra-Guillén C, Monteagudo C, López Guerrero JA, Sanmartín O. Dermatofibrosarcoma protuberans: a comprehensive review and update on diagnosis and management. Semin Diagn Pathol 2013; 30:13-28. [DOI: 10.1053/j.semdp.2012.01.002] [Citation(s) in RCA: 160] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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19
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Abstract
A 25-year-old lady presented with a small pea-sized lesion on left side of her neck, anteriorly. There was no history of any other lesion on her body. She was medically fit otherwise. An excision was planned, after taking consent from her, which was performed under local anaesthesia as a day procedure. Her postoperative recovery was uneventful. Histopathology showed dermatofibrosarcoma protuberance which is an extremely rare skin tumour. She was further investigated for metastasis. Her CT scan of chest, abdomen and pelvis was performed which showed prominent thymus. Other than this finding, no other abnormality was found in CT scan.
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Affiliation(s)
- Rizwan Aziz
- Department of Surgery, South West Acute Hospital, Enniskillen, UK.
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20
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Serra-Guillén C, Llombart B, Sanmartín O. Dermatofibrosarcoma Protuberans. ACTAS DERMO-SIFILIOGRAFICAS 2012. [DOI: 10.1016/j.adengl.2011.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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21
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Dermatofibrosarcoma protuberans. ACTAS DERMO-SIFILIOGRAFICAS 2012; 103:762-77. [DOI: 10.1016/j.ad.2011.10.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2011] [Revised: 10/26/2011] [Accepted: 10/29/2011] [Indexed: 11/24/2022] Open
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22
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Merkel cell carcinoma: a retrospective study on 48 cases and review of literature. JOURNAL OF ONCOLOGY 2012; 2012:749030. [PMID: 23024654 PMCID: PMC3449125 DOI: 10.1155/2012/749030] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/19/2012] [Revised: 06/28/2012] [Accepted: 08/13/2012] [Indexed: 11/18/2022]
Abstract
Merkel cell carcinoma (MCC) is a rare and aggressive neuroendocrine tumor of the skin. Fourty-eight patients with MCC were observed at the Rare Hormonal Tumors Group of Cremona Hospital, 15 of these with unknown primary site. Due to rarity of Merkel cell carcinoma, clinical experience is generally limited. Data from our series confirm the current recommendations. Wide surgical excision must be associated with radiotherapy also in early stages in order to avoid local relapse and the rapid progression of disease. In advanced stages chemotherapy is the standard despite the short duration of responses and poor quality of life. The data of our series, characterized by a high demand for second opinion, offer some insight about the real rarity of the tumor, the difficulty of managing of disease in our country secondary to a wrong cultural approach to the problem, the indiscriminate use of molecules unnecessary and often expensive, the lack of protocols, and the presence of guidelines often ignored. This results in very poor survival associated with a very low quality of life, requiring to find the right direction towards a correct management of disease.
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23
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Stivala A, Lombardo GAG, Pompili G, Tarico MS, Fraggetta F, Perrotta RE. Dermatofibrosarcoma protuberans: Our experience of 59 cases. Oncol Lett 2012; 4:1047-1055. [PMID: 23162649 DOI: 10.3892/ol.2012.887] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2012] [Accepted: 05/11/2012] [Indexed: 11/05/2022] Open
Abstract
Dermatofibrosarcoma protuberans (DFSP) is a rare soft tissue tumor with intermediate malignancy. It is initially located on the skin from where it is able to infiltrate the deep structures and has a tendency to recur locally following inadequate excision. A t(17;22)(q22;q13) chromosome trans-location is the main cytogenetic alteration responsible for the onset of DFSP. Treatment options include complete surgical excision by performing conventional surgery with wide margins (>3 cm) or Mohs micrographic surgery. A retrospective study was conducted in our Department of Plastic and Reconstructive Surgery and all data were collected from medical records of 59 DFSP patients within this department from 1999 to 2011. A total of 13 of 59 (22%) cases were treated with conventional excision; 3 (5%) cases resulted in tumor-free margins, 8 (14%) cases required surgical revision and 2 (3%) cases lead to recurrence. A total of 46 of 59 (78%) cases were treated with wide excision; 43 (73%) cases resulted in tumor-free margins, 3 (5%) cases required surgical revision and 0 (0%) cases lead to recurrence. In conclusion, the data collected reveal the controversy surrounding the adoption of general guidelines regarding safe margins. Further studies are required to investigate the possibility of obtaining genotypically altered margins from margins that may appear phenotypically healthy.
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Affiliation(s)
- Alessio Stivala
- Department of Medical and Surgery Specialties, Section of Plastic Surgery
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24
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Bogucki B, Neuhaus I, Hurst EA. Dermatofibrosarcoma Protuberans: A Review of the Literature. Dermatol Surg 2012; 38:537-51. [DOI: 10.1111/j.1524-4725.2011.02292.x] [Citation(s) in RCA: 88] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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25
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Sin FNY, Wong KW. Dermatofibrosarcoma protuberans of the breast: a case report. Clin Imaging 2012; 35:398-400. [PMID: 21872132 DOI: 10.1016/j.clinimag.2011.04.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2009] [Accepted: 09/10/2009] [Indexed: 10/17/2022]
Abstract
Dermatofibrosarcoma protuberans (DFSP) is an uncommon mesenchymal tumour of the dermis and subcutis, which most commonly appears on the body and the extremities. Its occurrence in the breast is rare, and when it does, it can mimic a primary, benign breast lesion. We present a case of DFSP over the breast of a patient together with the associated imaging findings that can potentially help us differentiate this tumour from a primary breast lesion. The awareness of this entity allows a prompt diagnosis to be made and the disease to be properly managed.
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Affiliation(s)
- Francesca Nga-yee Sin
- Department of Radiology, HLG 1, Main Block, Princess Margaret Hospital, Lai Chi Kok, Kowloon, Hong Kong.
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26
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Iqbal CW, St. Peter S, Ishitani MB. Pediatric Dermatofibrosarcoma Protuberans: Multi-Institutional Outcomes. J Surg Res 2011; 170:69-72. [DOI: 10.1016/j.jss.2011.01.042] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2010] [Revised: 01/12/2011] [Accepted: 01/20/2011] [Indexed: 02/07/2023]
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27
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Alsaleh QA, Nanda A, Al-Ajmi H, Al-Sabah H, Elkashlan M, Al-Shemmari S, Demierre MF. Clinicoepidemiological features of mycosis fungoides in Kuwait, 1991-2006. Int J Dermatol 2011; 49:1393-8. [PMID: 21155090 DOI: 10.1111/j.1365-4632.2010.04567.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Mycosis fungoides (MF) is an indolent, most common type of cutaneous T-cell lymphoma (CTCL) with an average estimated incidence of 0.5 cases per 100,000 persons per year in the western world. Although various clinical and epidemiological features are well delineated in the western population, the data is scarce from our region. OBJECTIVES To study the clinicoepidemiological features of MF from Kuwait. SETTING A referral photobiology unit for cutaneous lymphomas in a national dermatology department in collaboration with three other dermatology departments in Kuwait and Kuwait cancer center. PATIENTS AND METHODS One hundred and ninety-three cases of MF registered between July 1991 and June 2006 were included for this study. RESULTS Eighty-six percent of our MF cases were of Arab ethnicity. Males outnumbered the females by 2:1 ratio. Mean age at diagnosis was 35.20 ± 14.37 years, and 16% of the patients were diagnosed by the age 20 years. The annual incidence rate (IR) of MF in Kuwait was observed to be 0.43 cases per 100,000 persons with a significantly higher IR among Arabs as compared to non-Arab Asians (RR = 4.4; 95% CI = 2.9-6.6). A successive rise in the IR of MF was noticed with the advancing age. The annual IR among males was more or less comparable to that of females. Skin patches were the most prevalent skin lesions (67%) at diagnosis, and 22% of the patients had a pure hypopigmented variant. Patients with hypopigmented MF were observed to have younger mean age at diagnosis (27.60 ± 12.42 years) as compared to other MF cases (38.14 ± 14.37 years) (P = 0.000). Ninety-two percent of the patients had the early stage (IA, IB, and IIA) of disease. CONCLUSIONS Our patients with MF were observed to have a relatively younger age at diagnosis, with a high proportion of patients diagnosed by the age 20 years. Arabs were observed to have a higher annual IR of MF as compared to non-Arab Asians. Hypopigmented MF is prevalent in our population. The study highlights the ethnic and/or regional variations in the clinicoepidemiological characteristics of MF.
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Affiliation(s)
- Qasem A Alsaleh
- As'ad Al-Hamad Dermatology Center, Al-Sabah Hospital, Kuwait.
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28
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Agelli M, Clegg LX, Becker JC, Rollison DE. The etiology and epidemiology of merkel cell carcinoma. Curr Probl Cancer 2010; 34:14-37. [PMID: 20371072 DOI: 10.1016/j.currproblcancer.2010.01.001] [Citation(s) in RCA: 134] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Affiliation(s)
- Maria Agelli
- Department of Health and Human Services, National Institutes of Health, National Cancer Institute, Bethesda, MD, USA
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29
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Shih PY, Chen CH, Kuo TT, Yang CY, Huang YH, Yang CH. Deep dermatofibrosarcoma protuberans: a pitfall in the ultrasonographic diagnosis of lipoma-like subcutaneous lesions. DERMATOL SIN 2010. [DOI: 10.1016/s1027-8117(10)60005-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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30
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Riou-Gotta MO, Fournier E, Danzon A, Pelletier F, Levang J, Mermet I, Blanc D, Humbert P, Aubin F. Rare skin cancer: a population-based cancer registry descriptive study of 151 consecutive cases diagnosed between 1980 and 2004. Acta Oncol 2009; 48:605-9. [PMID: 19137462 DOI: 10.1080/02841860802680435] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND There are few epidemiological data available on rare skin cancer, including Merkel cell carcinoma, Paget's disease, adnexal carcinoma, and sarcoma. We conducted this study to investigate the epidemiology of rare skin cancer diagnosed in the department of Doubs from 1980 to 2004. METHODS Data were collected from a population-based cancer registry from 1980 to 2004. Diagnosis was based on the 3(rd) edition of the International Classification of Diseases for Oncology. The incidence rates were standardized on world population. RESULTS One hundred and fifty one patients were investigated (88 women and 63 men). Median age for the diagnosed disease was 63 years. The standardized incidence rate was 0.82/100 000 person-year (95% CI = 0.68-0.96) and increased from 0.25 in 1980-1984 to 1.50 in 2000-2004. Fifty nine cases (39%) were sarcomas, 35 (23%) adnexal carcinomas, 27 (18%) Merkel cell carcinoma and 27 (18%) Paget's disease. The standardized incidence rates were 0.37/100 000 (0.27-0.47) for sarcomas, 0.16 (0.10-0.22) for adnexal tumors, 0.13 (0.08-0.18) for Merkel cell carcinoma, and 0.15 (0.09-0.21) for Paget's disease. CONCLUSIONS Our results based on a population-based cancer registry showed an increase of the standardized incidence rate for all types of rare skin tumors. These results may be useful when considering the growing interest in rare diseases in identifying risk factors and planning scientific research programmes.
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31
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Kukko H, Vuola J, Suominen S, Koljonen V. Merkel cell carcinoma in a young pregnant woman. J Plast Reconstr Aesthet Surg 2008; 61:1530-3. [PMID: 17664089 DOI: 10.1016/j.bjps.2007.06.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2006] [Accepted: 06/19/2007] [Indexed: 11/28/2022]
Abstract
SUMMARY We present a 27-year-old pregnant woman with Merkel cell carcinoma on the forehead. In early pregnancy, the lesion was excised as an epidermal cyst. It was only after recurrence that a diagnosis of Merkel cell carcinoma was made. Sentinel-node biopsy, excision with 2 cm margins and reconstruction with free microvascular radial forearm flap was carried out, and the patient received postoperative radiotherapy. No evidence of recurrence or disease progression was found 24 months after surgery.
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Affiliation(s)
- H Kukko
- Department of Plastic Surgery, Helsinki University Hospital, Finland.
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33
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Drug Insight: histone deacetylase inhibitor-based therapies for cutaneous T-cell lymphomas. ACTA ACUST UNITED AC 2008; 5:714-26. [DOI: 10.1038/ncponc1238] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2007] [Accepted: 03/07/2008] [Indexed: 01/16/2023]
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34
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Boghossian V, Owen ID, Nuli B, Xiao PQ. Neuroendocrine (Merkel cell) carcinoma of the retroperitoneum with no identifiable primary site. World J Surg Oncol 2007; 5:117. [PMID: 17949500 PMCID: PMC2117014 DOI: 10.1186/1477-7819-5-117] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2007] [Accepted: 10/19/2007] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Neuroendocrine carcinoma is an aggressive neoplasm that mainly affects elderly Caucasians and typically arises in sun-exposed areas of the skin. The disease is rather rare and only a relatively few cases present with no apparent primary lesion. CASE PRESENTATION We report a case of an 81-year-old Caucasian male with neuroendocrine carcinoma, which initially presented as a large retroperitoneal mass. Pathological and immunohistochemical analysis of the transabdominal CT-guided biopsy specimen revealed tissue consistent with neuroendocrine carcinoma. The patient underwent exploratory laparotomy and the mass was successfully excised along with an associated mesenteric lymph node. DISCUSSION There are currently two possible explanations for what occurred in our patient. First, the retroperitoneal mass could be a massively enlarged lymph node where precursor cells became neoplastic. This would be consistent with a presumptive diagnosis of primary nodal disease. Alternatively, an initial skin lesion could have spontaneously regressed and the retroperitoneal mass represents a single site of metastasis. Since Merkel cell precursors have never been identified within lymph nodes, the latter theory seems more befitting. Moreover, metastasis to the retroperitoneal lymph nodes has been reported as relatively common when compared to other sites such as liver, bone, brain and skin. CONCLUSION Wide local excision of the primary tumor is the surgical treatment of choice for localized disease. We propose that further studies are needed to elucidate the true efficacy of chemotherapy in conventional as well as unconventional patients with neuroendocrine carcinoma.
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Affiliation(s)
- Van Boghossian
- Department of Surgery, Brooklyn Hospital Center, 121 Dekalb Ave, Brooklyn, New York, NY 11201, USA.
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35
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Sanmartín O, Llombart B, López-Guerrero JA, Serra C, Requena C, Guillén C. Dermatofibrosarcoma protuberans. ACTAS DERMO-SIFILIOGRAFICAS 2007; 98:77-87. [PMID: 17397592 DOI: 10.1016/s0001-7310(07)70019-4] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Dermatofibrosarcoma protuberans (DFSP) is a soft tissue neoplasm of intermediate malignancy that is initially localized to the skin from where it can invade deep structures (fat, fascia, muscle and bone). It is the most frequent fibrohistiocytic tumor, comprising approximately 1.8 % of all soft tissue sarcomas and 0.1 % of all cancers. It has an estimated incidence of 0.8-5 cases per one million persons per year. Treatment of localized disease consists in complete surgical excision of the lesion by conventional surgery with wide margins (>3 cm) or by micrographic Mohs surgery. Although the cases of metastatic DFSP do not reach 5 % of the total, almost all of them appear after previous local relapses. The prognosis for metastatic cases is very poor with a survival of less than 2 years following detection of metastatic disease. Patients with locally advanced DFSP are not candidates for an initial radical surgical therapy therefore neoadyuvant treatment is required prior to surgery in order to reduce tumor burden. In this regard, chemotherapy and radiotherapy have not been highly efficacious so it is necessary to consider new alternatives. The demonstration of the oncogenic power of the translocation COL1A1-PDGFB in DFSP has allowed the successful introduction of drug therapy with antagonists of the PDGFB receptor for metastatic or locally advanced cases.
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MESH Headings
- Antigens, CD34/analysis
- Antineoplastic Agents/therapeutic use
- Benzamides
- Biomarkers, Tumor/analysis
- Chemotherapy, Adjuvant
- Chromosomes, Human, Pair 17/ultrastructure
- Chromosomes, Human, Pair 22/genetics
- Chromosomes, Human, Pair 22/ultrastructure
- Combined Modality Therapy
- Dermatofibrosarcoma/chemistry
- Dermatofibrosarcoma/classification
- Dermatofibrosarcoma/drug therapy
- Dermatofibrosarcoma/genetics
- Dermatofibrosarcoma/pathology
- Dermatofibrosarcoma/surgery
- Drug Design
- Humans
- Imatinib Mesylate
- Mohs Surgery
- Neoadjuvant Therapy
- Neoplasm Invasiveness
- Neoplasm Proteins/analysis
- Neoplasm Proteins/genetics
- Neoplasm Recurrence, Local
- Oncogene Proteins, Fusion/analysis
- Oncogene Proteins, Fusion/genetics
- Piperazines/therapeutic use
- Prognosis
- Pyrimidines/therapeutic use
- Receptor, Platelet-Derived Growth Factor beta/antagonists & inhibitors
- Ring Chromosomes
- Sarcoma/chemistry
- Sarcoma/drug therapy
- Sarcoma/genetics
- Sarcoma/pathology
- Sarcoma/surgery
- Skin Neoplasms/chemistry
- Skin Neoplasms/drug therapy
- Skin Neoplasms/genetics
- Skin Neoplasms/pathology
- Skin Neoplasms/surgery
- Translocation, Genetic
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Affiliation(s)
- O Sanmartín
- Servicio de Dermatología, Instituto Valenciano de Oncología, Valencia, España.
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36
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Criscione VD, Weinstock MA. Descriptive epidemiology of dermatofibrosarcoma protuberans in the United States, 1973 to 2002. J Am Acad Dermatol 2006; 56:968-73. [PMID: 17141362 DOI: 10.1016/j.jaad.2006.09.006] [Citation(s) in RCA: 180] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2006] [Revised: 09/01/2006] [Accepted: 09/06/2006] [Indexed: 10/23/2022]
Abstract
BACKGROUND The epidemiology of dermatofibrosarcoma protuberans (DFSP) has not been studied in detail. OBJECTIVE We sought to describe patterns of DFSP incidence and survival in the United States. METHODS Data were obtained from 9 population-based cancer registries of the Surveillance, Epidemiology, and End Results Program for 1973 to 2002. RESULTS DFSP overall annual incidence was 4.2 per million. Incidence increased by 43% (3.1-4.4 per million per year) during the study period, but this increase was restricted to whites. Annual incidence among blacks (6.5 per million) was almost double the incidence among whites (3.9 per million; P < .005, 95% confidence interval of difference 2.02-3.22). Women had higher rates of incidence than men (4.4 vs 4.2 per million per year; P = .052, 95% confidence interval of difference -0.002 to 0.60), except among the elderly. Relative 5-year survival was 99.2% (95% confidence interval 98.3-100%). LIMITATIONS The Surveillance, Epidemiology, and End Results Program lacks independent verification of diagnoses and case detail. CONCLUSIONS The racial differences in the incidence of DFSP are significant, and the cause is unknown. Previous literature had suggested that men were more frequently affected, which was not true in our data. The tumor rarely results in death. Epidemiologic investigation using population-based data is important to better understand this disorder.
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Affiliation(s)
- Vincent D Criscione
- Dermatoepidemiology Unit, Veterans Affairs Medical Center, and Department of Dermatology, Brown University, Providence, Rhode Island 02908-4799, USA
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38
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Monnier D, Vidal C, Martin L, Danzon A, Pelletier F, Puzenat E, Algros MP, Blanc D, Laurent R, Humbert PH, Aubin F. Dermatofibrosarcoma protuberans: a population-based cancer registry descriptive study of 66 consecutive cases diagnosed between 1982 and 2002. J Eur Acad Dermatol Venereol 2006; 20:1237-42. [PMID: 17062038 DOI: 10.1111/j.1468-3083.2006.01780.x] [Citation(s) in RCA: 91] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Dermatofibrosarcoma protuberans (DFSP) is a rare malignant tumour of the skin, with an estimated incidence of 0.8 to five cases per 1 million people per year. OBJECTIVE To study epidemiological, immunohistochemical and clinical features, delay in diagnosis, type of treatment and outcome of DFSP from 1982 to 2002. METHODS Using data from the population-based cancer registry, 66 patients with pathologically proved DFSP were included (fibrosarcomatous DFSP were excluded). Each patient lived in one of the four departments of Franche-Comté (overall population of 1 million people) at the time of diagnosis. The main data sources came from public and private pathology laboratories and medical records. The rules of the International Agency for Research on Cancer were applied. RESULTS The estimated incidence of DFSP in Franche-Comté was about three new cases per 1 million people per year. Male patients were affected 1.2 times as often as female patients were. The trunk (45%) followed by the proximal extremities (38%) were the most frequent locations. DFSP occurred mainly in young adults between 20 and 39 years of age. Mean age at diagnosis was 43 years, and the mean delay in diagnosis was 10.08 years. Our 66 patients initially underwent a radical local excision. Among them, 27% experienced one or more local recurrences during 9.6 years of follow-up. There was one regional lymph node recurrence without visceral metastases. These recurrences were significantly related to the initial peripheral resection margins. We observed a local recurrence rate of 47% for margins less than 3 cm, vs. only 7% for margins ranging from 3 to 5 cm [P=0.004; OR=0.229 (95%, CI=0.103-0.510)]. The mean time to a first local recurrence was 2.65 years. Nevertheless, there was no death due to the DFSP course at the end of the follow-up, and the final outcome was favourable. CONCLUSION Our study emphasizes the importance of wide local excision with margins of at least 3 cm in order to prevent local recurrence. However, the recent development of inhibitors of signal transduction by the PDGFB pathway should soon modify the surgical strategy, which is often too mutilating.
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Affiliation(s)
- D Monnier
- Department of Dermatology, Orléans Hospital, Orléans, France
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39
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Morales-Suárez-Varela MM, Olsen J, Johansen P, Kaerlev L, Guénel P, Arveux P, Wingren G, Hardell L, Ahrens W, Stang A, Llopis A, Merletti F, Guillen-Grima F, Masala G. Occupational Sun Exposure and Mycosis Fungoides: A European Multicenter Case???Control Study. J Occup Environ Med 2006; 48:390-3. [PMID: 16607193 DOI: 10.1097/01.jom.0000194160.95468.20] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE We sought to study the association between occupational sun exposure and mycosis fungoides (MF), a peripheral T-cell lymphoma. SUBJECTS AND METHODS A European multicenter case-control study including seven rare cases (one being MF) was conducted between 1995 and 1997. From the 118 accepted cases, 104 were interviewed, of which 76 were definite cases. Population controls were selected randomly from the regions of case ascertainment. Information based on occupational experiences was coded according to industry types. A job exposure matrix was created according to the expected exposure to sunlight. RESULTS Once exposures to aromatic halogenated hydrocarbons were eliminated (odds ratio = 2.3; 95% confidence interval = 0.9-6.2), a high MF risk was associated with exposures to solar radiation. CONCLUSION It would appear that workers exposed to sunlight have a higher risk of MF. However, this factor is not the only one involved.
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40
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Abstract
Background Merkel cell carcinoma (MCC) is an unusual primary neuroendocrine carcinoma of the skin. MCC is a fatal disease, and patients have a poor chance of survival. Moreover, MCC lacks distinguishing clinical features, and thus by the time the diagnosis is made, the tumour usually have metastasized. MCC mainly affects sun-exposed areas of elderly persons. Half of the tumours are located in the head and neck region. Methods MCC was first described in 1972. Since then, most of the cases reported, have been in small series of patients. Most of the reports concern single cases or epidemiological studies. The present study reviews the world literature on MCC. The purpose of this article is to shed light on this unknown neuroendocrine carcinoma and provide the latest information on prognostic markers and treatment options. Results The epidemiological studies have revealed that large tumour size, male sex, truncal site, nodal/distant disease at presentation, and duration of disease before presentation, are poor prognostic factors. The recommended initial treatment is extensive local excision. Adjuvant radiation therapy has recently been shown to improve survival. Thus far, no chemotherapy protocol have achieved the same objective. Conclusion Although rare, the fatality of this malignancy makes is important to understand the etiology and pathophysiology. During the last few years, the research on MCC has produced prognostic markers, which can be translated into clinical patient care.
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Affiliation(s)
- Virve Koljonen
- Department of Plastic Surgery, Helsinki University Hospital, Helsinki Finland.
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41
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Martin L, Piette F, Blanc P, Mortier L, Avril MF, Delaunay MM, Dréno B, Granel F, Mantoux F, Aubin F, Sassolas B, Adamski H, Dalac S, Pauwels C, Dompmartin A, Lok C, Estève E, Guillot B. Clinical variants of the preprotuberant stage of dermatofibrosarcoma protuberans. Br J Dermatol 2006; 153:932-6. [PMID: 16225602 DOI: 10.1111/j.1365-2133.2005.06823.x] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Some cases of dermatofibrosarcoma protuberans (DFSP) do not protrude above the skin. OBJECTIVES To assess the prevalence of these DFSPs and further to describe their presentation and course. METHODS One hundred and forty-three patients were retrospectively collected. They were asked to complete a standardized questionnaire indicating the history and appearance of the DFSP from the first skin changes identified to the time of diagnosis. RESULTS Eighty-one DFSPs were described as protuberant ab initio, and 62 as initially nonprotuberant (npDFSP). The latter remained at this stage for a mean period of 7.6 years. Twenty-nine per cent of npDFSPs were 'morphoea-like', 19% were 'atrophoderma-like' and 42% were 'angioma-like'. Age at diagnosis was similar for both initial presentations. npDFSPs were most often misdiagnosed by physicians. CONCLUSIONS Nearly half the patients first identified their early DFSP-related skin changes as patches. Both this frequency and the long duration at this preprotuberant stage should prompt dermatologists to consider the diagnosis of DFSP earlier, in order to make surgical treatment easier.
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Affiliation(s)
- L Martin
- Department of Dermatology, Hôpital Porte-Madeleine, CHR Orléans, 45032 Orléans cedex 1, France.
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42
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Morales-Suárez-Varela MM, Olsen J, Johansen P, Kaerlev L, Guénel P, Arveux P, Wingren G, Hardell L, Ahrens W, Stang A, Llopis A, Merletti F, Aurrekoetxea JJ, Masala G. Occupational Exposures and Mycosis Fungoides. A European Multicentre Case–control Study (Europe). Cancer Causes Control 2005; 16:1253-9. [PMID: 16215876 DOI: 10.1007/s10552-005-0456-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2005] [Accepted: 06/27/2005] [Indexed: 10/25/2022]
Abstract
OBJECTIVES Mycosis Fungoides (MF) is a rare disease with an occurrence indicating that occupational exposures may play a role. To estimate the association between MF and occupational exposures as measured by means of an job-exposure matrix (JEM). METHODS A European multicenter case-control study was conducted from 1995 to 1997 and included seven rare cancers, one of which was MF. Patients between 35 and 69 years of age, diagnosed with MF (n=140), were recruited and the diagnoses were checked by a reference pathologist who classified 83 cases as definite, 35 cases as possible and 22 cases as not accepted. Among the 118 accepted cases, 104 cases were interviewed, of which 76 were definite cases. We selected population controls and colon cancer controls to serve all seven case groups. Altogether 833 colon cancer controls and 2071 population controls were interviewed. Based on the reported occupational experiences, a team of industrial hygiene specialists identified five potential exposures and developed an JEM. This JEM was used to estimate the odds ratios (OR) for MF as a function of these exposures. The JEM included aromatic and/or halogenated hydrocarbons (AAHs), chrome (VI) and its salts, electromagnetic radiations, silica and pesticides. RESULTS Exposures to AHHs (OR 6.3, C.I 2.4-16.7 for male) were associated with a high MF risk. CONCLUSIONS The study supports the hypothesis that some MFs have an occupational etiology but only a small fraction of exposed workers are apparently susceptible since the disease is so rare.
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43
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Chuang TY, Lewis DA, Spandau DF. Decreased incidence of nonmelanoma skin cancer in patients with type 2 diabetes mellitus using insulin: a pilot study. Br J Dermatol 2005; 153:552-7. [PMID: 16120142 DOI: 10.1111/j.1365-2133.2005.06738.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND In order to prevent the propagation of genetic mutations, human keratinocytes irradiated with ultraviolet (UV) B light in vitro undergo premature stress-induced senescence or apoptosis. This response to UVB irradiation is dependent on the functional activation of the insulin-like growth factor-1 receptor (IGF-1R). Based on this in vitro functional data, we hypothesized that the increased serum levels of insulin in patients with type 2 diabetes may activate the IGF-1R in skin and lead to a decreased frequency of skin cancer in these patients. OBJECTIVES To determine whether the use of insulin by patients with type 2 diabetes correlated with a change in the incidence in nonmelanoma skin cancer (NMSC). METHODS A historical cohort study identifying the incidence of NMSC following the use of two different pharmacological therapies. The patient population was restricted to caucasians who were at least 50 years old when they began the indicated pharmacological therapy. The first group consisted of 1440 patients who used insulin therapy to treat type 2 diabetes and the second group comprised 4135 patients who used cimetidine to treat their gastrointestinal ailments. An additional group of 6131 patients with diabetes who used noninsulin antidiabetics was added to examine the effect of noninsulin therapies. All patients had regular follow-up visits at the Regenstrief Clinics during the study period between 1980 and 1999. The Regenstrief Clinics is an outpatient facility which serves the general population in Metro-Indianapolis, Indiana, U.S.A. RESULTS The incidence of NMSC in patients using insulin was significantly lower than in patients using cimetidine (1.25% vs. 2.35%, P < 0.02). The decrease in NMSC in patients with type 2 diabetes correlated specifically with the use of insulin (NMSC incidence insulin-only patients with diabetes: 1.40% vs. those with diabetes using noninsulin therapies: 2.35%, P = 0.11). CONCLUSIONS Patients using exogenous insulin had a lower risk of developing NMSC and the protective effect of insulin use becomes more distinct with increasing age.
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Affiliation(s)
- T-Y Chuang
- Department of Dermatology, Indiana University School of Medicine, Indianapolis, Indiana, USA
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44
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Abstract
Merkel cell carcinoma (MCC) is an uncommon, aggressive neuroendocrine carcinoma of the skin. Its prognosis is poor because of involvement of regional lymph nodes and metastases to distant sites such as bone, liver, lung, and brain. Very few metastases are reported to the gastrointestinal tract. Several studies have shown the utility of cytokeratin 20 to differentiate MCC from other small round blue cell tumors, particularly those with neuroendocrine differentiation. In this case report, we present an unusual metastasis to the stomach and the utility of cytokeratin 20 immunohistochemistry to confirm MCC.
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Affiliation(s)
- Melissa Li
- Department of Pathology, University of Florida College of Medicine, Gainesville, FL, USA.
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45
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Kim EJ, Hess S, Richardson SK, Newton S, Showe LC, Benoit BM, Ubriani R, Vittorio CC, Junkins-Hopkins JM, Wysocka M, Rook AH. Immunopathogenesis and therapy of cutaneous T cell lymphoma. J Clin Invest 2005; 115:798-812. [PMID: 15841167 PMCID: PMC1070436 DOI: 10.1172/jci24826] [Citation(s) in RCA: 214] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Cutaneous T cell lymphomas (CTCLs) are a heterogenous group of lymphoproliferative disorders caused by clonally derived, skin-invasive T cells. Mycosis fungoides (MF) and Sezary syndrome (SS) are the most common types of CTCLs and are characterized by malignant CD4(+)/CLA(+)/CCR4(+) T cells that also lack the usual T cell surface markers CD7 and/or CD26. As MF/SS advances, the clonal dominance of the malignant cells results in the expression of predominantly Th2 cytokines, progressive immune dysregulation in patients, and further tumor cell growth. This review summarizes recent insights into the pathogenesis and immunobiology of MF/SS and how these have shaped current therapeutic approaches, in particular the growing emphasis on enhancement of host antitumor immune responses as the key to successful therapy.
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Affiliation(s)
- Ellen J Kim
- Department of Dermatology, University of Pennsylvania School of Medicine and the Wistar Institute, Philadelphia, Pennsylvania 19104, USA.
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46
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Koljonen V, Jahkola T, Tukiainen E, Granroth G, Haglund C, Böhling T. Tenascin-C in primary Merkel cell carcinoma. J Clin Pathol 2005; 58:297-300. [PMID: 15735164 PMCID: PMC1770604 DOI: 10.1136/jcp.2004.018432] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND/AIMS Merkel cell carcinoma (MCC) is a rare malignant cutaneous neuroendocrine tumour that mostly affects the elderly. It shows rapid progression of the primary tumour, together with a vertical growth pattern into the underlying subcutaneous tissue. Metastatic dissemination to regional lymph nodes is early and frequent. Tenascin-C (Tn-C) is a large extracellular matrix glycoprotein that is expressed in various benign and malignant processes. Expression of Tn-C is also associated with invasion and cellular proliferation, and is often downregulated in fully evolved advanced carcinomas. In previous studies, Tn-C expression correlated with prognosis in tumours of different origin. METHODS Immunohistochemistry was used to investigate the expression of Tn-C in 25 MCC specimens and to evaluate the prognostic importance of this glycoprotein. RESULTS Seventeen samples expressed Tn-C. Staining was mainly seen in the invasion borders and within the connective tissue septae inside the tumours. The expression of Tn-C correlated significantly with large tumour size. There was also frequent expression of Tn-C in primary tumours with metastatic dissemination. Most of the Tn-C negative samples were of small size. CONCLUSIONS Tn-C expression seems to increase with tumour size and malignant behaviour. Expression was slightly enhanced in tumours with high proliferative indices. Expression is seen mainly in areas of invasive growth and, in this respect, resembles that of other invasive tumours.
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Affiliation(s)
- V Koljonen
- Department of Plastic Surgery, Helsinki University Hospital, Helsinki, 00029 HUS, Finland.
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47
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Bukhari I, Al Akloby O, Bedaiwi Y. Dermatofibrosarcoma protuberans at the site of a central venous line. Case report. Am J Clin Dermatol 2005; 6:61-4. [PMID: 15675891 DOI: 10.2165/00128071-200506010-00007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Dermatofibrosarcoma protuberans (DFSP) is a locally aggressive cutaneous tumor that usually does not metastasize. Clinically, it may present as a reddish macule to protuberant nodule affecting the trunk and proximal extremities of young and middle-aged adults. Histologically, it is characterized by a monomorphous storiform proliferation of spindle cells, involving the dermis and hypodermis, with a honeycomb pattern of infiltration of the subcutaneous fat. In case of difficulty in diagnosis, immunohistochemical markers (especially CD34) are highly sensitive for DFSP. It is important to remember that the rarity of DFSP, its resemblance to hypertrophied scars and keloids, and its appearance at trauma sites sometimes make the diagnosis of DFSP difficult and delayed. In the literature, DSFP was not described in a child until 1957. Here we report an instance of DFSP at an unusual site in a 9-year-old child, which was the location of a previous central venous line insertion in the left supraclavicular area. A complete excision of the tumor with a wide surgical margin of 3cm of visibly uninvolved tissue was performed, followed by a deltopectoral flap and skin split graft. Postoperatively, the patient's general condition was stable and he was discharged after 5 days to be followed up 3 months later in our clinic.
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Affiliation(s)
- Iqbal Bukhari
- Dermatology Department, King Faisal University, College of Medicine, Alkhobar, Saudi Arabia
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48
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Koljonen V, Lassus P, Tukiainen E, Ristimäki A, Haglund C, Böhling T. Cyclooxygenase-2 expression in primary Merkel cell carcinoma. J Cutan Pathol 2005; 32:55-8. [PMID: 15660656 DOI: 10.1111/j.0303-6987.2005.00262.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Merkel cell carcinoma (MCC) is a highly malignant neuroendocrine skin tumor. The typical course of MCC is rapid progression of the primary tumor and metastatic dissemination to the regional lymph nodes. Thus far, no biological, prognostic marker has been established for this aggressive neoplasm. Cyclooxygenase-2 (Cox-2) is undetectable in most normal tissues, but it is induced in various cell types by inflammation and carcinogenesis. Although the expression and function of Cox-2 have been studied extensively in several carcinomas, little is known about Cox-2 expression in neuroendocrine carcinomas. The aim of the present report was to study Cox-2 expression in MCC and find out whether this expression correlates with outcome. METHODS Immunohistochemical analysis for Cox-2 was performed on 22 primary MCC samples. RESULTS Almost 70% of the samples showed positive staining. Protein expression of Cox-2 was sparse and low in intensity. We found a tendency for enhanced Cox-2 expression in tumors located in sun-exposed areas. Cox-2 expression had no significant statistical correlation with clinical parameters. CONCLUSIONS MCC expresses Cox-2 in low levels, and the expression did not prove to be a prognostic factor. Furthermore, the low expression suggests that the primary treatment option for MCC is not therapeutic inhibition of Cox-2.
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Affiliation(s)
- Virve Koljonen
- Department of Plastic Surgery, Helsinki University Hospital, Helsinki University, Helsinki, Finland.
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49
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Eng TY, Boersma MGK, Fuller CD, Cavanaugh SX, Valenzuela F, Herman TS. Treatment of Merkel Cell Carcinoma. Am J Clin Oncol 2004; 27:510-5. [PMID: 15596922 DOI: 10.1097/01.coc.0000135567.62750.f4] [Citation(s) in RCA: 72] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of this study was to evaluate the treatment of Merkel cell carcinoma. MATERIALS AND METHODS We reviewed 85 cases of Merkel cell carcinoma. There were 68 males and 17 females. The majority of cases involved head and neck sites (48%), followed by the extremities (38%) and trunk (14%). Sixty-seven percent of the patients had stage I disease that was localized to the skin of origin at presentation. Twenty-five percent and 8% were stage II (nodal metastasis) and stage III (distant metastasis), respectively. Surgical intervention included local or wide local excision +/- nodal dissection (68%), radical resection +/- nodal dissection (22%), and amputation (4%). Five patients (6%) underwent biopsy only because of metastatic disease or unresectability at presentation. Fifty-one percent received adjuvant therapy consisting of external beam radiation therapy and/or combination chemotherapy. RESULTS With an average follow-up time of 39.5 months, 12% had persistent disease and 40% had recurrent disease. The median time to recurrence was 8 months with a mean of 10.6 months. Although the addition of adjuvant therapy did not affect survival, the recurrence rate was 32.5% for surgery +/- adjuvant radiation therapy +/- chemotherapy as compared with 52.7% for surgery-only patients. Although the 40.7% recurrence rate for patients receiving surgery and adjuvant radiation therapy was approximately the same as for patients receiving surgery and adjuvant chemotherapy (40%), the effect of systemic chemotherapy on recurrence is less clear as a result of the small number of patients who received such therapy. Although tumor size and site of presentation were not observed to be statistically significant in overall survival, significant differences were observed based on sex and tumor stage. For females, the median survival time was 96 months (mean, 94.5 months) compared with 63 months (mean, 76.8 months) for males. This difference was significant (P < 0.01). Patients presenting with low-stage (stage I) disease had a significant (P < 0.01) survival benefit when compared with high-stage individuals (stages II and III). The 5-year actuarial survival rates were 68% and 42%, respectively. CONCLUSION In this retrospective study, surgery remains the primary modality for Merkel cell carcinoma, and adjuvant radiation therapy +/- systemic chemotherapy reduces local recurrence. Female patients and those who present with early-stage disease appear to have a better prognosis.
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Affiliation(s)
- Tony Y Eng
- Department of Radiation Oncology, University of Texas, Health Science Center at San Antonio/CTRC, San Antonio, Texas 78229, USA.
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50
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Agelli M, Clegg LX. Epidemiology of primary Merkel cell carcinoma in the United States. J Am Acad Dermatol 2004; 49:832-41. [PMID: 14576661 DOI: 10.1016/s0190-9622(03)02108-x] [Citation(s) in RCA: 378] [Impact Index Per Article: 18.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Merkel cell carcinoma (MCC) is a rare, aggressive skin cancer. OBJECTIVE We sought to describe primary MCC incidence trends, epidemiology, and predictors of survival. METHODS The population covered by the Surveillance, Epidemiology, and End Results Program was analyzed as a prospective cohort. We measured age-adjusted incidence rates (per 100,000 person-years) and effect of age, anatomic site, and stage on survival. RESULTS Incidence was higher in males (0.34) than in females (0.17). Cases (n = 1034) occurred mostly in whites (94%), in people older than 65 years (76%), and at the head (48%). The 5-year relative survival was 75%, 59%, and 25% for localized, regional, and distant MCC, respectively. Female sex, limb presentation, localized disease, and younger age were positive predictors of survival. CONCLUSION The highest incidence of MCC was observed in whites, males, and in people older than 65 years. Only 49% of cases were reported as localized. Better survival was associated with limb localization, early-stage disease, younger age, and female sex.
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