■我们描述了用pembrolizumab(免疫检查点抑制剂)治疗转移性头皮黑色素瘤的患者的病例。他以前有结肠直肠癌病史,前列腺癌和慢性风湿性多肌痛。已知该患者具有4.5cm的稳定升主动脉瘤。然而,他发展了升主动脉瘤的快速扩张,其大小超过了手术的阈值。患者被转介到心胸外科服务机构进行干预,随后接受了手术。患者在一周后选择性入院切除主动脉瘤,主动脉成形术和外部移植物固定。病理上,没有发现解剖的严重证据;然而,培养基的组织学分析显示层状内侧坏死,本质上是多焦点,偶尔有组织细胞簇在其边缘欣赏,让人想起在炎性主动脉炎(肉芽肿/巨细胞型)中看到的。
■免疫检查点抑制剂引起的主动脉炎越来越明显,和它的表现可以有所不同。在使用nivolumab的监视成像中偶然发现了它。在其他情况下,患者有症状至严重症状.据报道,阿特珠单抗联合卡铂和依托泊苷可引起腹主动脉炎,对皮质类固醇有反应,随后停用阿特珠单抗。Pembrolizumab与横行主动脉弓主动脉炎病例有关。在我们的案例中,pembrolizumab引起的炎性主动脉炎是升主动脉瘤快速扩张的原因.
■患有已知主动脉瘤的患者在开始免疫检查点抑制剂治疗时应进行仔细监测。
结论:免疫检查点抑制剂越来越多地用于治疗转移性恶性肿瘤。然而,它们是一组相对较新的药物,而每一种的副作用特征还没有得到充分认识。使用几种不同的免疫检查点抑制剂已经发生了主动脉炎。已知主动脉瘤的患者在开始使用免疫检查点抑制剂时应进行仔细监测。在动脉瘤扩张的发展中,应在这些患者的早期考虑所有介入治疗方案。
UNASSIGNED: We describe a case of a patient treated with pembrolizumab (an immune checkpoint inhibitor) for metastatic scalp melanoma. He had a previous history of colorectal cancer, prostatic cancer and chronic polymyalgia rheumatica. The patient was known to have a stable ascending aortic aneurysm of 4.5 cm. However, he developed a rapid expansion of the ascending aortic aneurysm with the size crossing the threshold for surgery. The patient was referred to the cardiothoracic surgery service for intervention and he subsequently underwent surgery. The patient was electively admitted one week later for resection of aortic aneurysm, aortoplasty and external graft fixation. Pathologically, gross evidence of dissection was not identified; however, the histological analysis of the media showed laminar medial necrosis, multifocal in nature, with occasional clusters of histiocytic cells appreciated at their edge reminiscent of that seen in an inflammatory
aortitis (granulomatous/giant cell type).
UNASSIGNED: Immune checkpoint inhibitor-induced
aortitis is becoming increasingly evident, and its presentation can vary. It has been discovered incidentally on surveillance imaging with the use of nivolumab. In other cases, patients have been symptomatic to severely symptomatic. Atezolizumab with carboplatin and etoposide has been reported to cause abdominal aortitis which was responsive to corticosteroids and subsequent discontinuation of atezolizumab. Pembrolizumab has been linked to a case of transverse aortic arch
aortitis. In our case, the inflammatory
aortitis due to pembrolizumab was the cause of the rapid expansion of the ascending aortic aneurysm.
UNASSIGNED: Patients with known aortic aneurysms should undergo careful surveillance when commencing immune-checkpoint inhibitor therapy.
CONCLUSIONS: Immune checkpoint inhibitors are being increasingly used in the treatment of metastatic malignancy. However, they are a relatively new group of medications, and the side effect profile of each is yet to be fully recognised.
Aortitis has occurred with several different immune checkpoint inhibitors.Patients with known aortic aneurysms should undergo careful surveillance when commencing immune checkpoint inhibitors.All interventional therapeutic options should be considered early in these patients on the development of aneurysmal expansion.