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Rana HS, Dertinger JE, Clabeaux C, Makepeace N, Lewis J. Metastatic Melanoma to the Orbit With Dedifferentiation: A Case Report. Cureus 2023; 15:e41591. [PMID: 37559849 PMCID: PMC10408357 DOI: 10.7759/cureus.41591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/08/2023] [Indexed: 08/11/2023] Open
Abstract
We present the first documented case of metastatic melanoma to the orbit with dedifferentiation. A patient with a history of melanoma of the lip and other poorly differentiated carcinomas presented with both a sub-brow and an intraorbital mass. Radiographically and intraoperatively, the sub-brow mass communicated with the intraorbital mass via perineural spread along the supraorbital nerve. Histopathology confirmed the diagnosis of melanoma based on the melanocytic markers, SOX-10 and Melan-A; dedifferentiation was demonstrated within the orbital tumor. Two weeks following surgical debulking, the intraorbital mass returned to its full size. Local radiotherapy and immunotherapy were performed, which initially led to a dramatic improvement; however, the patient succumbed to his systemic metastases six months later. Dedifferentiation serves as a prognostic indicator and should be considered in patients when histopathology does not lead to a definitive diagnosis.
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Affiliation(s)
- Harkaran S Rana
- Ophthalmology, Walter Reed National Military Medical Center, Bethesda, USA
| | - Jake E Dertinger
- Ophthalmology, California Health Sciences University College of Osteopathic Medicine, Clovis, USA
| | | | - Nicole Makepeace
- Ophthalmology, Walter Reed National Military Medical Center, Bethesda, USA
| | - Jason Lewis
- Ophthalmology, Walter Reed National Military Medical Center, Bethesda, USA
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Abstract
Though metastasis and malignant infiltration of the peripheral nervous system is relatively rare, physicians should have a familiarity with their presentations to allow for prompt diagnosis and initiation of treatment. This article will review the clinical presentations, diagnostic evaluation, and treatment of neoplastic involvement of the cranial nerves, nerve roots, peripheral nerves, and muscle. Due to the proximity of the neural structure traversing the skull base, metastasis to this region results in distinctive syndromes, most often associated with breast, lung, and prostate cancer. Metastatic involvement of the nerve roots is uncommon, apart from leptomeningeal carcinomatosis and bony metastasis with resultant nerve root damage, and is characterized by significant pain, weakness, and numbness of an extremity. Neoplasms may metastasize or infiltrate the brachial and lumbosacral plexuses resulting in progressive and painful sensory and motor deficits. Differentiating neoplastic involvement from radiation-induced injury is of paramount importance as it dictates treatment and prognosis. Neurolymphomatosis, due to malignant lymphocytic infiltration of the cranial nerves, nerve roots, plexuses, and peripheral nerves, deserves special attention given its myriad presentations, often mimicking acquired demyelinating neuropathies.
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De Logu F, Marini M, Landini L, Souza Monteiro de Araujo D, Bartalucci N, Trevisan G, Bruno G, Marangoni M, Schmidt BL, Bunnett NW, Geppetti P, Nassini R. Peripheral Nerve Resident Macrophages and Schwann Cells Mediate Cancer-Induced Pain. Cancer Res 2021; 81:3387-3401. [PMID: 33771895 DOI: 10.1158/0008-5472.can-20-3326] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 02/13/2021] [Accepted: 03/22/2021] [Indexed: 12/16/2022]
Abstract
Although macrophages (MΦ) are known to play a central role in neuropathic pain, their contribution to cancer pain has not been established. Here we report that depletion of sciatic nerve resident MΦs (rMΦ) in mice attenuates mechanical/cold hypersensitivity and spontaneous pain evoked by intraplantar injection of melanoma or lung carcinoma cells. MΦ-colony stimulating factor (M-CSF) was upregulated in the sciatic nerve trunk and mediated cancer-evoked pain via rMΦ expansion, transient receptor potential ankyrin 1 (TRPA1) activation, and oxidative stress. Targeted deletion of Trpa1 revealed a key role for Schwann cell TRPA1 in sciatic nerve rMΦ expansion and pain-like behaviors. Depletion of rMΦs in a medial portion of the sciatic nerve prevented pain-like behaviors. Collectively, we identified a feed-forward pathway involving M-CSF, rMΦ, oxidative stress, and Schwann cell TRPA1 that operates throughout the nerve trunk to signal cancer-evoked pain. SIGNIFICANCE: Schwann cell TRPA1 sustains cancer pain through release of M-CSF and oxidative stress, which promote the expansion and the proalgesic actions of intraneural macrophages. GRAPHICAL ABSTRACT: http://cancerres.aacrjournals.org/content/canres/81/12/3387/F1.large.jpg.
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Affiliation(s)
- Francesco De Logu
- Department of Health Sciences, Clinical Pharmacology Unit, University of Florence, Florence, Italy
| | - Matilde Marini
- Department of Health Sciences, Clinical Pharmacology Unit, University of Florence, Florence, Italy
| | - Lorenzo Landini
- Department of Health Sciences, Clinical Pharmacology Unit, University of Florence, Florence, Italy
| | | | - Niccolò Bartalucci
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Gabriela Trevisan
- Graduated Program in Pharmacology, Federal University of Santa Maria (UFSM), Avenida Roraima, Santa Maria, Brazil
| | - Gennaro Bruno
- Department of Health Sciences, Clinical Pharmacology Unit, University of Florence, Florence, Italy.,Division of Pediatric Oncology/Hematology, Meyer University Children's Hospital, Florence, Italy
| | - Martina Marangoni
- Department of Health Sciences, Clinical Pharmacology Unit, University of Florence, Florence, Italy
| | - Brian L Schmidt
- Department of Oral and Maxillofacial Surgery, Bluestone Center for Clinical Research, New York University College of Dentistry, New York, New York
| | - Nigel W Bunnett
- Department of Molecular Pathobiology, College of Dentistry, Department of Neuroscience and Physiology, and Neuroscience Institute, School of Medicine, New York University, New York
| | - Pierangelo Geppetti
- Department of Health Sciences, Clinical Pharmacology Unit, University of Florence, Florence, Italy.
| | - Romina Nassini
- Department of Health Sciences, Clinical Pharmacology Unit, University of Florence, Florence, Italy
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Kovanda TJ, Rabbani C, Ting JY, Bonnin JM, Williams BJ, Savage JJ. Endoscopic transpterygoid approach for resection of trigeminal neurotropic melanoma: Case report and technical note. Interdisciplinary Neurosurgery 2020. [DOI: 10.1016/j.inat.2019.100558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Dubernard X, Brenet E, Makeieff M. A falsely silent mass. Eur Ann Otorhinolaryngol Head Neck Dis 2018; 135:371-372. [PMID: 29910100 DOI: 10.1016/j.anorl.2018.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- X Dubernard
- Service d'oto-rhino-laryngologie, CHU de Reims, rue du General-Koening, 51100 Reims, France.
| | - E Brenet
- Service d'oto-rhino-laryngologie, CHU de Reims, rue du General-Koening, 51100 Reims, France
| | - M Makeieff
- Service d'oto-rhino-laryngologie, CHU de Reims, rue du General-Koening, 51100 Reims, France
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Abstract
Cancer in the form of solid tumors, leukemia, and lymphoma can infiltrate and metastasize to the peripheral nervous system, including the cranial nerves, nerve roots, cervical, brachial and lumbosacral plexuses, and, rarely, the peripheral nerves. This review discusses the presentation, diagnostic evaluation, and treatment options for metastatic lesions to these components of the peripheral nervous system and is organized based on the anatomic distribution. As skull base metastases (also discussed in Chapter 14) result in cranial neuropathies, these will be covered in detail, as well as cancers that directly infiltrate the cranial nerves. Particular emphasis is placed on the clinical, imaging, and electrodiagnostic features that differentiate neoplastic plexopathies from radiation-induced plexopathies. Neurolymphomatosis, in which malignant lymphocytes invade the cranial nerves, nerve roots, brachial and lumbosacral plexuses, and peripheral nerves, is a rare manifestation of lymphoma and leukemia. Diagnoses of neurolymphomatosis are often missed or delayed given its varied presentations, resulting in poorer outcomes. Thus this disease will also be discussed in depth.
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Affiliation(s)
- Kelly G Gwathmey
- Department of Neurology, University of Virginia, Charlottesville, VA, United States.
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Erkan S, Acharya AN, Savundra J, Lewis SB, Rajan GP. En Bloc Resection of Desmoplastic Neurotropic Melanoma with Perineural Invasion of the Intracranial Trigeminal and Intraparotid Facial Nerve: Case Report and Review of the Literature. J Neurol Surg Rep 2016; 77:e008-12. [PMID: 26929895 PMCID: PMC4726377 DOI: 10.1055/s-0035-1566254] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Accepted: 09/14/2015] [Indexed: 12/31/2022] Open
Abstract
Background Desmoplastic neurotropic melanoma (DNM) is a rare, highly malignant, and locally invasive form of cutaneous melanoma with a tendency for perineural invasion (PNI). Methods We report a case of a 61-year-old man presenting with right-sided trigeminal neuralgia and progressive facial paresis due to the PNI of the intracranial trigeminal nerve and the intraparotid facial nerve from DNM. We also present a review of the literature with six cases of DNM with PNI of the intracranial trigeminal nerve identified. Results The combined transtemporal-infratemporal fossa approach was performed to achieve total en bloc resection of the tumor mass followed by postoperative radiotherapy (PORT). After 24 months of follow-up, the patient remains disease free with no signs of recurrence on magnetic resonance imaging. Conclusion We recommend the en bloc resection of the tumor mass followed by PORT for the management of DNM with PNI. A high index of suspicion for PNI as a cause of cranial neuropathies is essential for the early detection and treatment of patients with known melanoma.
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Affiliation(s)
- Serkan Erkan
- Department of Otolaryngology, Head and Surgery, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - Aanand N Acharya
- Department of Otolaryngology, Head and Surgery, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - James Savundra
- Department of Plastics Surgery, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Stephen B Lewis
- Perth Neurosurgery, Hollywood Medical Centre, Nedlands, Western Australia, Australia
| | - Gunesh P Rajan
- Department of Otolaryngology, Head and Surgery, Fiona Stanley Hospital, Murdoch, Western Australia, Australia; Skull Base Division, Otolaryngology, Head and Neck Surgery, University of Western Australia, Murdoch, Western Australia, Australia
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Tritschler P, Rezazadeh Azar A, De Coene B, Maraite N, Michotte A. Trigeminal melanoma metastasis. Clin Neuroradiol 2014; 24:51-4. [PMID: 23344462 DOI: 10.1007/s00062-012-0195-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2012] [Accepted: 12/28/2012] [Indexed: 10/27/2022]
Abstract
We present the case of a 70-year-old patient presented to our institution for paresthesia of the right hemiface associated with dysarthria in aggravation since 1 year. He was diagnosed with right trigeminal melanoma metastasis. This case is characterized by a thickening of the right trigeminal nerve from his cisternal segment to his mandibular branch V3. MRI demonstrated an intensive perineural spread by a melanotic melanoma.
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