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Shaker N, Li Z, Bamporiki J, Sangueza OP, Abid A. Cutaneous balloon-cell melanoma metastases to the axillary lymph node: Exploring cytomorphologic features and differential diagnoses on fine needle aspiration biopsy. Cytopathology 2024; 35:427-431. [PMID: 38196078 DOI: 10.1111/cyt.13354] [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: 11/09/2023] [Revised: 12/13/2023] [Accepted: 12/21/2023] [Indexed: 01/11/2024]
Abstract
Balloon cell melanoma (BCM) is an exceptionally uncommon histological variant, making up <1% of all malignant melanomas. Diagnosing balloon cell melanoma on cytological specimens can be challenging due to its scarcity and its similarity to other medical conditions. A comprehensive clinical assessment and histological analysis, coupled with immunohistochemical staining, play a crucial role in distinguishing balloon cell melanoma from various benign and malignant skin conditions. The differential diagnoses encompass spitz nevus, balloon cell nevus, clear cell sarcoma of tendons and aponeuroses (melanoma of soft tissues), metastatic clear cell renal cell carcinoma, sebaceous carcinoma, and benign adnexal tumours like clear cell hidradenoma.Malignant melanoma encompasses a spectrum of histopathological subtypes, each with unique clinical and cytological characteristics. Notably, balloon‐cell melanoma (BCM) emerges as an exceptionally rare and diagnostically challenging variant. Marked by the presence of distinct balloon‐like, clear cytoplasmic vacuoles within melanoma cells, BCM stands apart from other melanoma subtypes. Despite its rarity, the distinctive cytological features of BCM make it a compelling subject of investigation, emphasizing the crucial role of Fine Needle Aspiration (FNA) cytology in ensuring accurate diagnosis and guiding subsequent management decisions.
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Affiliation(s)
- Nada Shaker
- Department of Pathology, The Ohio State University Wexner Medical Center/James Cancer Hospital, Columbus, Ohio, USA
| | - Zaibo Li
- Department of Pathology, The Ohio State University Wexner Medical Center/James Cancer Hospital, Columbus, Ohio, USA
| | | | - Omar P Sangueza
- Departments of Dermatology and Pathology, Wake Forest University, School of Medicine, Medical Center Boulevard, Winston-Salem, North Carolina, USA
| | - Abdul Abid
- Department of Pathology, University of Virginia Health, Charlottesville, Virginia, USA
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Trac N, Chen Z, Oh HS, Jones L, Huang Y, Giblin J, Gross M, Sta Maria NS, Jacobs RE, Chung EJ. MRI Detection of Lymph Node Metastasis through Molecular Targeting of C-C Chemokine Receptor Type 2 and Monocyte Hitchhiking. ACS NANO 2024; 18:2091-2104. [PMID: 38212302 DOI: 10.1021/acsnano.3c09201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/13/2024]
Abstract
Biopsy is the clinical standard for diagnosing lymph node (LN) metastasis, but it is invasive and poses significant risk to patient health. Magnetic resonance imaging (MRI) has been utilized as a noninvasive alternative but is limited by low sensitivity, with only ∼35% of LN metastases detected, as clinical contrast agents cannot discriminate between healthy and metastatic LNs due to nonspecific accumulation. Nanoparticles targeted to the C-C chemokine receptor 2 (CCR2), a biomarker highly expressed in metastatic LNs, have the potential to guide the delivery of contrast agents, improving the sensitivity of MRI. Additionally, cancer cells in metastatic LNs produce monocyte chemotactic protein 1 (MCP1), which binds to CCR2+ inflammatory monocytes and stimulates their migration. Thus, the molecular targeting of CCR2 may enable nanoparticle hitchhiking onto monocytes, providing an additional mechanism for metastatic LN targeting and early detection. Hence, we developed micelles incorporating gadolinium (Gd) and peptides derived from the CCR2-binding motif of MCP1 (MCP1-Gd) and evaluated the potential of MCP1-Gd to detect LN metastasis. When incubated with migrating monocytes in vitro, MCP1-Gd transport across lymphatic endothelium increased 2-fold relative to nontargeting controls. After administration into mouse models with initial LN metastasis and recurrent LN metastasis, MCP1-Gd detected metastatic LNs by increasing MRI signal by 30-50% relative to healthy LNs. Furthermore, LN targeting was dependent on monocyte hitchhiking, as monocyte depletion decreased accumulation by >70%. Herein, we present a nanoparticle contrast agent for MRI detection of LN metastasis mediated by CCR2-targeting and demonstrate the potential of monocyte hitchhiking for enhanced nanoparticle delivery.
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Affiliation(s)
- Noah Trac
- Department of Biomedical Engineering, University of Southern California, Los Angeles, California 90089, United States
| | - Zixi Chen
- Department of Biomedical Engineering, University of Southern California, Los Angeles, California 90089, United States
| | - Hyun-Seok Oh
- Department of Biomedical Engineering, University of Southern California, Los Angeles, California 90089, United States
| | - Leila Jones
- Department of Biomedical Engineering, University of Southern California, Los Angeles, California 90089, United States
| | - Yi Huang
- Department of Biomedical Engineering, University of Southern California, Los Angeles, California 90089, United States
| | - Joshua Giblin
- Department of Biomedical Engineering, University of Southern California, Los Angeles, California 90089, United States
| | - Mitchell Gross
- Lawrence J. Ellison Institute for Transformative Medicine, Los Angeles, California 90064, United States
- Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, California 90033, United States
| | - Naomi S Sta Maria
- Department of Physiology and Neuroscience, Zilkha Neurogenetic Institute and Keck School of Medicine, University of Southern California, Los Angeles, California 90033, United States
| | - Russell E Jacobs
- Department of Physiology and Neuroscience, Zilkha Neurogenetic Institute and Keck School of Medicine, University of Southern California, Los Angeles, California 90033, United States
| | - Eun Ji Chung
- Department of Biomedical Engineering, University of Southern California, Los Angeles, California 90089, United States
- Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, California 90033, United States
- Division of Nephrology and Hypertension, Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California 90089, United States
- Department of Medicine, Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, California 90089, United States
- Department of Medicine, Eli and Edythe Broad Center for Regenerative Medicine and Stem Cell Research, Keck School of Medicine, University of Southern California, Los Angeles, California 90089, United States
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California 90089, United States
- Mork Family Department of Chemical Engineering and Materials Science, University of Southern California, Los Angeles, California 90089, United States
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Wei C, Sun W, Shen K, Zhong J, Liu W, Gao Z, Xu Y, Wang L, Hu T, Ren M, Li Y, Zhu Y, Zheng S, Zhu M, Luo R, Yang Y, Hou Y, Qi F, Zhou Y, Chen Y, Gu J. Delineating the early dissemination mechanisms of acral melanoma by integrating single-cell and spatial transcriptomic analyses. Nat Commun 2023; 14:8119. [PMID: 38065972 PMCID: PMC10709603 DOI: 10.1038/s41467-023-43980-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 11/24/2023] [Indexed: 12/18/2023] Open
Abstract
Acral melanoma (AM) is a rare subtype of melanoma characterized by a high incidence of lymph node (LN) metastasis, a critical factor in tumor dissemination and therapeutic decision-making. Here, we employ single-cell and spatial transcriptomic analyses to investigate the dynamic evolution of early AM dissemination. Our findings reveal substantial inter- and intra-tumor heterogeneity in AM, alongside a highly immunosuppressive tumor microenvironment and complex intercellular communication networks, particularly in patients with LN metastasis. Notably, we identify a strong association between MYC+ Melanoma (MYC+MEL) and FGFBP2+NKT cells with LN metastasis. Furthermore, we demonstrate that LN metastasis requires a metabolic shift towards fatty acid oxidation (FAO) induced by MITF in MYC+MEL cells. Etomoxir, a clinically approved FAO inhibitor, can effectively suppress MITF-mediated LN metastasis. This comprehensive dataset enhances our understanding of LN metastasis in AM, and provides insights into the potential therapeutic targeting for the management of early AM dissemination.
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Affiliation(s)
- Chuanyuan Wei
- Department of Plastic and Reconstructive Surgery, Zhongshan Hospital, Fudan University, Shanghai, 200032, P. R. China
- Cancer center, Zhongshan Hospital, Fudan University, Shanghai, 200032, P. R. China
| | - Wei Sun
- Department of Musculoskeletal Oncology, Fudan University Shanghai Cancer Center, Shanghai, 200032, P. R. China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, P. R. China
| | - Kangjie Shen
- Department of Plastic and Reconstructive Surgery, Zhongshan Hospital, Fudan University, Shanghai, 200032, P. R. China
- Cancer center, Zhongshan Hospital, Fudan University, Shanghai, 200032, P. R. China
| | - Jingqin Zhong
- Department of Musculoskeletal Oncology, Fudan University Shanghai Cancer Center, Shanghai, 200032, P. R. China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, P. R. China
| | - Wanlin Liu
- Department of Musculoskeletal Oncology, Fudan University Shanghai Cancer Center, Shanghai, 200032, P. R. China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, P. R. China
| | - Zixu Gao
- Department of Plastic and Reconstructive Surgery, Zhongshan Hospital, Fudan University, Shanghai, 200032, P. R. China
- Cancer center, Zhongshan Hospital, Fudan University, Shanghai, 200032, P. R. China
| | - Yu Xu
- Department of Musculoskeletal Oncology, Fudan University Shanghai Cancer Center, Shanghai, 200032, P. R. China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, P. R. China
| | - Lu Wang
- Department of Plastic and Reconstructive Surgery, Zhongshan Hospital, Fudan University, Shanghai, 200032, P. R. China
- Cancer center, Zhongshan Hospital, Fudan University, Shanghai, 200032, P. R. China
| | - Tu Hu
- Department of Musculoskeletal Oncology, Fudan University Shanghai Cancer Center, Shanghai, 200032, P. R. China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, P. R. China
| | - Ming Ren
- Department of Plastic and Reconstructive Surgery, Zhongshan Hospital, Fudan University, Shanghai, 200032, P. R. China
- Cancer center, Zhongshan Hospital, Fudan University, Shanghai, 200032, P. R. China
| | - Yinlam Li
- Department of Plastic and Reconstructive Surgery, Zhongshan Hospital, Fudan University, Shanghai, 200032, P. R. China
- Cancer center, Zhongshan Hospital, Fudan University, Shanghai, 200032, P. R. China
| | - Yu Zhu
- Department of Plastic and Reconstructive Surgery, Zhongshan Hospital, Fudan University, Shanghai, 200032, P. R. China
- Cancer center, Zhongshan Hospital, Fudan University, Shanghai, 200032, P. R. China
| | - Shaoluan Zheng
- Department of Plastic and Reconstructive Surgery, Xiamen Branch of Zhongshan Hospital, Fudan University, Xiamen, 361015, P. R. China
| | - Ming Zhu
- Department of Plastic and Reconstructive Surgery, Zhongshan Hospital, Fudan University, Shanghai, 200032, P. R. China
- Cancer center, Zhongshan Hospital, Fudan University, Shanghai, 200032, P. R. China
| | - Rongkui Luo
- Department of Pathology, Zhongshan Hospital, Fudan University, Shanghai, 200032, P. R. China
| | - Yanwen Yang
- Department of Plastic and Reconstructive Surgery, Zhongshan Hospital, Fudan University, Shanghai, 200032, P. R. China
- Cancer center, Zhongshan Hospital, Fudan University, Shanghai, 200032, P. R. China
| | - Yingyong Hou
- Department of Pathology, Zhongshan Hospital, Fudan University, Shanghai, 200032, P. R. China
| | - Fazhi Qi
- Department of Plastic and Reconstructive Surgery, Zhongshan Hospital, Fudan University, Shanghai, 200032, P. R. China
- Cancer center, Zhongshan Hospital, Fudan University, Shanghai, 200032, P. R. China
| | - Yuhong Zhou
- Department of Medical Oncology, Zhongshan Hospital, Fudan University, Shanghai, 200032, P. R. China.
| | - Yong Chen
- Department of Musculoskeletal Oncology, Fudan University Shanghai Cancer Center, Shanghai, 200032, P. R. China.
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, P. R. China.
| | - Jianying Gu
- Department of Plastic and Reconstructive Surgery, Zhongshan Hospital, Fudan University, Shanghai, 200032, P. R. China.
- Cancer center, Zhongshan Hospital, Fudan University, Shanghai, 200032, P. R. China.
- Department of Plastic and Reconstructive Surgery, Xiamen Branch of Zhongshan Hospital, Fudan University, Xiamen, 361015, P. R. China.
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Bobirca F, Leventer M, Georgescu DE, Dumitrescu DA, Alexandru C, Serban D, Valeanu L, Pătrașcu T, Bobircă A. Variability of Sentinel Lymph Node Location in Patients with Trunk Melanoma. Diagnostics (Basel) 2023; 13:2790. [PMID: 37685328 PMCID: PMC10486776 DOI: 10.3390/diagnostics13172790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 08/18/2023] [Accepted: 08/25/2023] [Indexed: 09/10/2023] Open
Abstract
(1) Background: Melanoma is one of the most aggressive types of neoplasia, and the management of this pathology requires a correct staging, as well as a personalized modern oncological treatment. The main objective of the study is to determine the variability of the lymphatic drainage for patients with melanomas located on the trunk and, secondarily, to determine the features of individuals who underwent sentinel lymph node biopsy (SLNB) depending on the exact location on the trunk. (2) Methods: This retrospective, observational, single-center study included 62 cases of trunk melanoma operated between July 2019 and March 2023, in which SLNB was performed and a total of 84 lymph nodes were excised. (3) Results: Patients had a median age of 54.5 (33-78) years, with 58.1% being male; the melanomas had a median Breslow index of 2.3 (0.5-12.5) mm. Approximately 64.3% of the cohort had melanoma on the upper part of the trunk (54 cases) and 35.7% had it on the lower part (30 cases). The type of anesthesia chosen was general anesthesia in 53 cases and spinal anesthesia in 9 cases (85.5% vs. 14.5%, p < 0.001). The number of sentinel lymph nodes excised was 54 for melanomas located on the upper part of the trunk (8 cervical and 46 axillary) and 30 sentinel lymph nodes for melanomas of the lower part of the trunk (16 at the axillary level and 14 at the inguinal level). Out of the 54 LNs identified in patients with melanoma on the upper part of the trunk, 13 were positive, with a total of 12 positive lymph nodes (LNs) from the axillar basin, and only one from the cervical region. Additionally, the incidence of patients with a minimum of two identified sentinel lymph nodes was 32.2%, with a total of seven having LN involvement in two basins, and only one of these cases showed positivity for malignancy. (4) Conclusions: SLNBs were more frequent in the axillary region overall, and had more positive SLNs. Moreover, melanoma on the upper part of the trunk had a higher rate of positive SLNs compared to the lower part. Tumors located on the lower part of the truck had more positive SLNs in the axillary region than in the inguinal one.
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Affiliation(s)
- Florin Bobirca
- Surgery Department, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Surgery Department, Dr. Ion Cantacuzino Clinical Hospital, 011437 Bucharest, Romania
| | | | - Dragos Eugen Georgescu
- Surgery Department, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Surgery Department, Dr. Ion Cantacuzino Clinical Hospital, 011437 Bucharest, Romania
| | - Dan Andrei Dumitrescu
- Surgery Department, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Surgery Department, Dr. Ion Cantacuzino Clinical Hospital, 011437 Bucharest, Romania
| | - Cristina Alexandru
- Internal Medicine and Rheumatology Department, Dr. Ion Cantacuzino Clinical Hospital, 011437 Bucharest, Romania
| | - Dragos Serban
- Surgery Department, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Liana Valeanu
- Department of Anesthesiology and Intensive Care, University of Medicine and Pharmacy “Carol Davila”, 050474 Bucharest, Romania
| | - Traian Pătrașcu
- Surgery Department, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Surgery Department, Dr. Ion Cantacuzino Clinical Hospital, 011437 Bucharest, Romania
| | - Anca Bobircă
- Internal Medicine and Rheumatology Department, Dr. Ion Cantacuzino Clinical Hospital, 011437 Bucharest, Romania
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