mucosal melanoma

粘膜黑色素瘤
  • 文章类型: Journal Article
    犬口腔黑色素瘤是犬中最常见的恶性肿瘤,由于其高侵袭性,高转移和复发率,预后较差。需要对其治疗进行更多研究并了解其致病因素。在这项研究中,我们分离了犬口腔粘膜黑色素瘤(COMM)细胞系,命名为COMM6605,现在已经稳定传代超过100代,成功的单克隆测定和22.2h的细胞增殖时间。COMM6605细胞系的G带核型分析显示,染色体计数异常,范围为45至74,鉴定出双臂染色体是该细胞系的特征性标记染色体。成功建立BALB/c-nu小鼠口腔舌内和背侧皮下植入模型;Melan-A(MLANA),S100β蛋白(S100β),PNL2,酪氨酸酶相关蛋白1(TRP1),酪氨酸酶相关蛋白2(TRP2)在犬口腔肿瘤切片中稳定表达,肿瘤细胞系,和荷瘤小鼠的肿瘤切片。SublinesCOMM6605-Luc-EGFP和COMM6605-Cherry通过慢病毒转染建立,与COMM6605-Luc-EGFP共表达萤火虫荧光素酶(Luc)和增强型绿色荧光蛋白(EGFP)和COMM6605-Cherry共表达樱桃荧光蛋白基因。经尾静脉注射COMM6605-Luc-EGFP荧光细胞亚系,引起肺和淋巴结转移,通过鼠标实时成像检测到,可以用作动物模型来模拟肿瘤转移过程中血行扩散的后期步骤。在本研究中分离和表征的犬口腔黑素瘤细胞系COMM6605和两个亚系可以为研究粘膜黑素瘤提供有价值的模型。
    Canine oral melanoma is the most prevalent malignant tumor in dogs and has a poor prognosis due to its high aggressiveness and high metastasis and recurrence rates. More research is needed into its treatment and to understand its pathogenic factors. In this study, we isolated a canine oral mucosal melanoma (COMM) cell line designated as COMM6605, which has now been stably passaged for more than 100 generations, with a successful monoclonal assay and a cell multiplication time of 22.2 h. G-banded karyotype analysis of the COMM6605 cell line revealed an abnormal chromosome count ranging from 45 to 74, with the identification of a double-armed chromosome as the characteristic marker chromosome of this cell line. The oral intralingual and dorsal subcutaneous implantation models of BALB/c-nu mice were successfully established; Melan-A (MLANA), S100 beta protein (S100β), PNL2, tyrosinase-related protein 1 (TRP1), and tyrosinase-related protein 2 (TRP2) were stably expressed positively in the canine oral tumor sections, tumor cell lines, and tumor sections of tumor-bearing mice. Sublines COMM6605-Luc-EGFP and COMM6605-Cherry were established through lentiviral transfection, with COMM6605-Luc-EGFP co-expressing firefly luciferase (Luc) and enhanced green fluorescent protein (EGFP) and COMM6605-Cherry expressing the Cherry fluorescent protein gene. The COMM6605-Luc-EGFP fluorescent cell subline was injected via the tail vein and caused lung and lymph node metastasis, as detected by mouse live imaging, which can be used as an animal model to simulate the latter steps of hematogenous spread during tumor metastasis. The canine oral melanoma cell line COMM6605 and two sublines isolated and characterized in this study can offer a valuable model for studying mucosal melanoma.
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  • 文章类型: Editorial
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  • 文章类型: English Abstract
    背景:原发性喉粘膜黑色素瘤是一种罕见的预后不良的肿瘤。通常很难诊断,应排除皮肤黑色素瘤的喉转移定位。
    方法:我们报告一例65岁男性原发性喉粘膜黑色素瘤,6年前接受放化疗和手术治疗右外侧口咽部鳞状细胞癌。在切除标本上做出原发性喉粘膜黑色素瘤的明确诊断,而在患者监测期间发现的上喉肿块的初始活检结果认为这是已知鳞状细胞癌的喉部复发。
    结论:通过这个案例,我们建议提醒这些肿瘤的主要特征和诊断缺陷。
    BACKGROUND: Primary laryngeal mucosal melanoma is a rare tumour with a poor prognosis. Its often difficult diagnosis should rule out laryngeal metastatic localization of cutaneous melanoma.
    METHODS: We report a case of primary laryngeal mucosal melanoma diagnosed in a 65-year-old man, treated 6 years previously with radio-chemotherapy and surgery for squamous cell carcinoma of the right lateral oropharyngeal region. The definitive diagnosis of primary laryngeal mucosal melanoma was made on the resection specimen, whereas the initial biopsy of the epilaryngeal mass discovered during the patient\'s surveillance had concluded that it was a laryngeal recurrence of the known squamous cell carcinoma.
    CONCLUSIONS: Through this case, we propose to remind the main characteristics and the diagnostic pitfalls of these tumours.
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  • 文章类型: Case Reports
    黑色素瘤导致大多数皮肤癌相关的死亡。尽管有新颖的治疗选择,转移性黑色素瘤的预后仍然较差.免疫检查点抑制(ICI)治疗已被证明可以延长晚期黑色素瘤患者的总体生存期。但是与皮肤来源的黑色素瘤相比,粘膜黑色素瘤的反应较差。我们报告了2020年6月诊断为直肠粘膜黑色素瘤的患者。由于为了实现无瘤状态的外科手术需要切除直肠,我们开始了伊匹单抗和纳武单抗的新辅助全身免疫疗法.作为复诊和结肠镜检查后四个剂量的这种联合免疫疗法显示部分反应,患者决定不进行预先计划的手术,并开始使用纳武单抗进行维持治疗.重复结肠镜检查显示四个剂量的纳武单抗后完全反应。在使用nivolumab进行ICI治疗后,没有肿瘤复发的证据,经过近2年的连续治疗,免疫疗法于2022年7月停止.患者在进一步随访期间保持无瘤。新辅助免疫疗法在晚期黑色素瘤中得到了更多的探索。通过在手术切除基本可手术的肿瘤之前给予ICI治疗,应该实现更强和更多样化的免疫反应。我们报道的病例表明,尽管对免疫疗法的反应通常较低,但这种方法在粘膜黑色素瘤中也可能有效。
    Melanoma causes the majority of skin cancer-related deaths. Despite novel therapy options, metastatic melanoma still has a poor prognosis. Immune checkpoint inhibition (ICI) therapy has been shown to prolong overall survival in patients with advanced melanoma, but mucosal melanomas respond less favorably compared to melanomas of cutaneous origin. We report on a patient with a mucosal melanoma of the rectum diagnosed in June 2020. Since a surgical intervention in order to achieve a tumor-free situation would have required an amputation of the rectum, a neo-adjuvant systemic immunotherapy with ipilimumab and nivolumab was initiated. As restaging and colonoscopy after four doses of this combination immunotherapy showed a partial response, the patient decided against the pre-planned surgery and a maintenance therapy with nivolumab was started. Repeated colonoscopy showed a complete response after four doses of nivolumab. After ongoing ICI therapy with nivolumab and no evidence of tumor relapse, immunotherapy was stopped in July 2022 after nearly 2 years of continuous treatment. The patient remained tumor-free during further follow-up. Neo-adjuvant immunotherapy is getting more explored in advanced melanoma. By administering ICI therapy before surgical resection of an essentially operable tumor, a stronger and more diverse immunological response is supposed to be achieved. Our reported case demonstrates that this approach could also be effective in mucosal melanoma despite of its generally lower response to immunotherapy.
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  • 文章类型: Case Reports
    背景:粘膜黑色素瘤,一种与头颈部常见的皮肤黑色素瘤不同的侵袭性恶性肿瘤,占所有恶性黑色素瘤的<1%。粘膜黑色素瘤的发病机制尚不清楚。在皮肤黑色素瘤中常见的靶向突变,比如在BRAF和NRAS基因中,粘膜黑色素瘤的发病率较低。粘膜黑素瘤携带与皮肤黑素瘤不同的突变模式。切缘阴性的手术是粘膜黑色素瘤的一线治疗,和系统治疗并不明确。Talimoenelaherparepvec,溶瘤病毒免疫疗法,是美国食品和药物管理局批准用于治疗晚期恶性皮肤黑色素瘤,具有局部治疗益处。粘膜黑色素瘤最初被排除在talimogenelaherparepvec的初始III期临床试验之外。
    方法:我们介绍了一名40多岁的白人女性患者,既往有系统性红斑狼疮病史,硬皮病,和雌激素受体阳性浸润性导管癌。双侧乳房切除术后,患者被发现患有BRAF阴性的硬腭粘膜黑色素瘤伴软腭跳跃病变.由于存在跳跃粘膜病变以及预期的缺损和需要游离皮瓣重建手术,考虑非手术治疗.病人被转诊到肿瘤内科,根据患者的复杂病史和免疫治疗的风险,可能使她先前的自身免疫性疾病恶化,选择了局部talimogenelaherparepvec注射作为她的粘膜病变的主要治疗方法。尽管talimogenelaherparepvec被批准用于皮肤黑色素瘤的治疗,关于在粘膜黑素瘤中使用talimogenelaherparepvec的可用数据有限。
    结论:患者在原发病灶以及局部注射后的跳跃病灶均有完全的局部肿瘤反应。她没有副作用,在治疗期间保持了高质量的生活。
    BACKGROUND: Mucosal melanoma, an aggressive type of malignancy different from the cutaneous melanomas commonly seen in the head and neck region, represents < 1% of all malignant melanomas. The pathogenesis of mucosal melanoma is unknown. Targetable mutations commonly seen in cutaneous melanoma, such as in the BRAF and NRAS genes, have a lower incidence in mucosal melanoma. Mucosal melanoma carries a distinct mutational pattern from cutaneous melanoma. Surgery with negative margins is the first-line treatment for mucosal melanoma, and systemic therapy is not well defined. Talimogene laherparepvec, an oncolytic viral immunotherapy, is United States Food and Drug Administration approved for the treatment of advanced malignant cutaneous melanoma, with local therapeutic benefits. Mucosal melanoma was initially excluded from talimogene laherparepvec\'s initial phase III clinical trial.
    METHODS: We present the case of a white female patient in her 40s with past medical history of systemic lupus erythematous, scleroderma, and estrogen-receptor-positive invasive ductal breast carcinoma. Following a bilateral mastectomy, the patient was found to have BRAF-negative mucosal melanoma of her hard palate with a soft palate skip lesion. Owing to the presence of a skip mucosal lesion as well as the anticipated defect and need for free-flap reconstructive surgery, nonsurgical management was considered. The patient was referred to medical oncology, where-based on the patient\'s complicated medical history and the risk of immunotherapy possibly worsening her prior autoimmune diseases-local talimogene laherparepvec injections were chosen as the primary therapy for her mucosal lesions. Though talimogene laherparepvec is approved for the treatment of cutaneous melanoma, there are limited data available on the use of talimogene laherparepvec in mucosal melanomas.
    CONCLUSIONS: The patient had a complete local tumor response at both the primary lesion as well as the skip lesion with the local injections. She had no side effects and maintained a high quality of life during treatment.
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  • 文章类型: Journal Article
    目的:鼻窦粘膜黑色素瘤(SNMM)是一种罕见的恶性肿瘤,以高(局部)复发率和低生存率为特征。目前缺乏对肿瘤病因的全面了解,这使得适当的肿瘤治疗复杂化。除了检查发病率的趋势,这项研究旨在评估临床特征之间的关联,治疗实践和患者结果,目的是建立可以增强SNMM管理的基线。
    方法:使用荷兰癌症登记处(NCR)的数据纳入了2001年至2021年荷兰所有新诊断的SNMM病例。
    结果:共纳入320例患者。在纳入期内,总体人群的年发病率是稳定的,年百分比变化(APC)仅为0.01%。5年总生存率(OS)和相对生存率(RS)分别为24.5%和32.4%,分别。相对存活率没有随时间增加。与单独手术相比,在手术中增加辅助放疗与较高的OS和RS无关。
    结论:鼻窦粘膜黑色素瘤是一种罕见的疾病,在2001年至2021年期间在荷兰发病率稳定。在纳入期内,生存率没有改善。该研究重申,辅助放疗似乎并不能改善患者的预后。鉴于SNMM患者的预后普遍较差,为了改善护理,应该考虑新的治疗方案。
    OBJECTIVE: Sinonasal mucosal melanoma (SNMM) is a rare malignancy, characterised by high (local) recurrence rates and poor survival. Comprehensive understanding of tumour etiology is currently lacking, which complicates adequate tumour treatment. Besides examining trends in incidence, this study aims to assess the association between clinical characteristics, treatment practices and patient outcomes, with the objective of establishing a baseline from which SNMM management can be enhanced.
    METHODS: All newly diagnosed SNMM cases in The Netherlands between 2001 and 2021 were included using data from The Netherlands Cancer Registry (NCR).
    RESULTS: A total of 320 patients were included. The annual incidence rate for the overall population was stable over the inclusion period with an annual percentage change (APC) of only - 0.01%. The 5-year overall survival (OS) and relative survival (RS) were 24.5 and 32.4%, respectively. Relative survival did not increase over time. The addition of adjuvant radiotherapy to surgery was not associated with a higher OS and RS compared to surgery alone.
    CONCLUSIONS: Sinonasal mucosal melanoma is a rare disease with stable incidence rates in the Netherlands between 2001 and 2021. There has been no improvement in survival over the course of the inclusion period. The study reaffirms that adjuvant radiotherapy does not seem to improve patient outcomes. Given the generally poor outcomes for SNMM patients, novel therapeutic options ought to be considered in order to improve care.
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  • 文章类型: Journal Article
    免疫检查点抑制剂疗法可以为患有某些癌症类型(包括黑色素瘤)的患者提供显著的临床益处;然而,仅在一部分患者中观察到客观反应.粘膜黑色素瘤是一种罕见的黑色素瘤亚型,与不良预后相关,与皮肤黑色素瘤相比,对免疫检查点抑制剂的反应明显减弱。自发性犬肿瘤已成为有价值的模型,为人类癌症研究提供信息。与人类黑色素瘤相反,大多数犬黑色素瘤是粘膜的,这种发病率可能被用来更好地了解人类的亚型。然而,需要对犬病的免疫景观有更全面的了解。这里,我们使用CD3和MAC387表达的免疫组织化学分析量化犬粘膜(n=13)和皮肤(n=5)黑素瘤中的肿瘤浸润性T细胞和骨髓细胞。分别。还使用犬IONanoString面板进行基因表达分析以鉴定与免疫细胞浸润相关的基因和途径。T和骨髓细胞密度是可变的,几何平均值分别为158.7细胞/mm2和166.7细胞/mm2。升高的T细胞浸润与细胞溶解基因以及编码共抑制检查点分子PD-1、CTLA-4、TIM-3和TIGIT的基因的表达增加相关;而增加的骨髓细胞浸润与原生细胞因子的表达升高相关。这些数据提供了犬恶性黑色素瘤肿瘤微环境的基本表征,并表明,就像人类黑色素瘤一样,抗肿瘤T细胞反应存在固有的变异性,并且犬黑色素瘤的一部分可能对免疫调节反应更好。
    Immune checkpoint inhibitor therapy can provide significant clinical benefit in patients with certain cancer types including melanoma; however, objective responses are only observed for a subset of patients. Mucosal melanoma is a rare melanoma subtype associated with a poor prognosis and, compared with cutaneous melanoma, is significantly less responsive to immune checkpoint inhibitors. Spontaneous canine tumours have emerged as valuable models to inform human cancer studies. In contrast to human melanoma, most canine melanomas are mucosal-an incidence that may be leveraged to better understand the subtype in humans. However, a more comprehensive understanding of the immune landscape of the canine disease is required. Here, we quantify tumour infiltrative T and myeloid cells in canine mucosal (n = 13) and cutaneous (n = 5) melanomas using immunohistochemical analysis of CD3 and MAC387 expression, respectively. Gene expression analysis using the Canine IO NanoString panel was also performed to identify genes and pathways associated with immune cell infiltration. T and myeloid cell densities were variable with geometric means of 158.7 cells/mm2 and 166.7 cells/mm2, respectively. Elevated T cell infiltration was associated with increased expression of cytolytic genes as well as genes encoding the coinhibitory checkpoint molecules PD-1, CTLA-4, TIM-3 and TIGIT; whereas increased myeloid cell infiltration was associated with elevated expression of protumourigenic cytokines. These data provide a basic characterization of the tumour microenvironment of canine malignant melanoma and suggest that, like human melanoma, inherent variability in anti-tumour T cell responses exists and that a subset of canine melanomas may respond better to immunomodulation.
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  • 文章类型: Case Reports
    鼻内粘膜黑色素瘤是一种罕见的黑色素瘤。表现为隐匿性恶性肿瘤的特征,进展迅速。表现为非特异性症状。到目前为止,尚未发现具体的危险因素.组织病理学和免疫组织化学检查有助于明确诊断。这里,我们介绍1例原发性鼻内黑色素粘膜黑素瘤并文献复习。
    作者介绍了一名患有原发性右侧鼻内黑色素粘膜黑色素瘤的患者。
    进行了内窥镜上颌骨内侧切除术,患者被联系到肿瘤科进行放疗。
    UNASSIGNED: Intranasal mucosal melanoma is a rare form of melanoma. Presenting as the features of occult malignancy and rapid in its progression. Presented with nonspecific symptoms. So far, no specific risk factor has been identified. The histopathological and immunohistochemical examination helps to confirm the diagnosis. Here, we present a case of primary intranasal melanotic mucosal melanoma and literature review.
    UNASSIGNED: The authors present a patient with primary right intranasal melanotic mucosal melanoma.
    UNASSIGNED: An endoscopic medial maxillectomy was done, and the patient was linked to the oncology department for radiotherapy.
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  • 文章类型: Case Reports
    背景:鼻窦粘膜黑色素瘤(SNMM)是一种罕见但侵袭性的疾病。有自由边缘的手术,在可行的情况下,是治疗的选择。在过去的三十年里,电化学疗法(ECT)已经成为一种局部消融程序,与诊所医生一起表演,用于不同组织学的皮肤和粘膜肿瘤。我们提供了通过新的内窥镜电极进行ECT治疗的病例报告,一名受原发性SNMM影响的老年患者。
    方法:一名88岁的男性,诊断为SNMM(cT4aN0M0)-IV期,在我们机构展示的左鼻窝。症状为鼻出血和完全左鼻塞。他拒绝鼻窦扩大手术和放疗。他接受了肿瘤消积术,然后进行了专门用于症状控制的ECT,有姑息的意图。
    结果:患者在全身麻醉下接受了SNMM减瘤,其次是肿瘤边缘的ECT。手术后,他已经5个月没有症状了,拥有良好的生活质量。通过新的局部切除和边缘的ECT手术控制了局部复发。患者在接下来的4个月内保持无症状。诊断后17个月,患者有轻微的鼻窦疾病症状。因此,他出现了全身性疾病进展。
    结论:根据我们的经验,当延长手术没有治愈意图或不可行时,ECT可用作SNMM症状和局部控制的辅助工具。不出所料,ECT似乎对全身性疾病进展没有任何影响。
    BACKGROUND: Sinonasal Mucosal Melanoma (SNMM) is a rare but aggressive disease. Surgery with free margins, when feasible, is the treatment of choice. In the last three decades, electrochemotherapy (ECT) has emerged as a local ablative procedure, performed with the Cliniporator, for cutaneous and mucosal tumours of different histology. We present a case report of an ECT treatment performed by means of a new endoscopic electrode, on an elderly patient affected by primary SNMM.
    METHODS: An 88-year-old man with a diagnosis of SNMM (cT4aN0M0)-Stage IV, of the left nasal fossa presented at our institution. Symptoms were epistaxis and complete left nasal obstruction. He refused sinonasal extended surgery and radiotherapy. He underwent a tumor debulking followed by ECT exclusively for symptom control, with palliative intent.
    RESULTS: The patient underwent SNMM debulking under general anaesthesia, followed by ECT on tumour margins. After the procedure, he had been free from symptoms for 5 months, with a good quality of life. Local recurrence was controlled with a new local debulking and ECT procedure on margins. The patient remained symptom free for the next 4 months. Seventeen months after diagnosis, the patient is mild symptomatic for sinonasal disease. Therefore, he developed a systemic disease progression.
    CONCLUSIONS: In our experience, ECT can be used as an adjuvant tool for symptom and local control in SNMM when extended surgery is out of curative intent or unfeasible. As expected, ECT does not appear to have any effect on systemic disease progression.
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  • 文章类型: Case Reports
    泌尿生殖道原发性恶性黑色素瘤极为罕见。我们在老年白人女性中出现了两个这样的病例。一名81岁女性,尿潴留和息肉样膀胱肿块,一名72岁女性,严重血尿和尿道骨。经过全面评估,他们最终都被诊断为原发性泌尿生殖道黑色素瘤(肿瘤细胞中SOX10和MART1阳性).在这两种情况下,原位黑色素瘤的存在和其他部位原发性黑色素瘤的不存在与原发性泌尿生殖道黑色素瘤一致.使用PD-1抑制剂进行免疫治疗以及使用新辅助和辅助治疗是有前途的,由于治疗指南尚不明确,总体生存率较低.原发性泌尿生殖道黑素瘤的其他临床报告可以帮助更好地理解并最终治疗它。
    膀胱和泌尿道的原发性黑色素瘤很少见,通常是致命的。它们只占所有黑色素瘤的0.2%,包括皮肤黑素瘤。由于它们的罕见性和缺乏明确的治疗指南,它们可能难以诊断和治疗。我们介绍了两例老年白人妇女,她们在接受手术并分析切除的组织后,意外地被诊断出患有膀胱和泌尿道原发性黑色素瘤。两种组织样本都具有黑色素瘤特有的特征,并且在任何其他器官中都没有癌症,从而使它们成为膀胱和泌尿道的原发性黑色素瘤。目前的手术和化疗治疗方法并没有改善与该疾病相关的生存结果和预后。但是手术前后的治疗以及利用患者自身免疫系统的癌症治疗是有希望的。通过报告这种通常致命疾病的额外临床经验,我们希望将来能够更好地理解和适当地管理它。
    Primary malignant melanoma of the genitourinary tract is extremely rare. We present two such cases in elderly Caucasian females. An 81-year-old female with urinary retention and polypoid urinary bladder mass and a 72-year-old female with gross hematuria and urethral caruncle. After thorough evaluation, they were both eventually diagnosed with primary urogenital melanoma (SOX10 and MART1-positive in tumor cells). In both cases, the presence of melanoma-in-situ and absence of primary melanoma in other sites were consistent with primary urogenital melanoma. Immunotherapy with PD-1 inhibitors and use of neoadjuvant and adjuvant treatment are promising, as treatment guidelines remain unclear and overall survival is low. Additional clinical reporting of primary urogenital melanomas can help in better understanding and ultimately treating it.
    Primary melanomas of the bladder and urinary tract are rare and usually deadly. They represent only 0.2% of all melanomas, including melanomas of skin. They can be difficult to diagnose and treat due to how rare they are and the lack of clear treatment guidelines. We present two cases of elderly Caucasian women who were unexpectedly diagnosed with primary melanoma cancers of the bladder and urinary tract after having surgery and analyzing tissue that was removed. Both tissue samples had features specific to melanoma and there was no cancer in any other organ, thus making them primary melanomas of the bladder and urinary tract. Current treatment approaches with surgery and chemotherapy have not improved the survival outcomes and prognosis associated with this disease, but treatment before and after surgery as well as cancer treatments that harness the person\'s own immune system are promising. By reporting additional clinical experiences of this often fatal disease, we hope it can be better understood and appropriately managed in the future.
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