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Cytotoxicity reactions during immunotherapy of melanoma with neuraminidase altered autologous tumor cells.

Lymphocyte cytotoxicity, serum cytotoxicity, and the ability of the serum to inhibit lymphocyte cytotoxicity (blocking effect) were studied in a melanoma patient treated with six monthly injections of her own (autologous) tumor cells incubated with neuraminidase to increase their antigenicity. The same tumor cells grown in tissue culture were used as target cells for the cytotoxicity test. Large fluctuations of blocking effect in the serum were found, which correlated with the clinical course of tumor removal, recurrence, and regression. After the fifth injection of autologous tumor cells, the blocking effect disappeared from the serum (unblocking). In general, changes in serum cytotoxicity corresponded with changes in the amount of blocking effect produced by the serum. The results suggest that active immunotherapy may play a role in the prevention of metastases and, that when used within the autologous system, the cytotoxicity test is valuable in studying response to this type of therapy.

Antigens, Neoplasm↗

["Blue" variant of naevus spilus].

We report on a 29-year-old female patient with an unusual pigmented lesion of the face. Clinically the lesion looked like a pigment patch of the naevus spilus type, while histological examination revealed the presence of dermal melanocytosis and multiple common blue naevi with a discrete lentiginous component in addition. The melanocytic nature of the infiltrate was ascertained by immunohistochemistry analysis using S 100 protein and HMB 45 antibodies. We interpret this lesion as agminated blue naevi in association with lentigo simplex, an unusual variant of speckled lentiginous naevus.

Adult↗

Maxillofacial deformities in neurofibromatosis.

Four patients with neurofibromatosis are described: all displayed the feature of an increased depth of the sigmoid notch probably due to an expansive growing neurofibroma of the inferior alveolar nerve. One patient had a local neurofibroma with an invasive growth pattern and only this patient shows hyperplasia of the bone. The suggestion is made, contrary to what is found in the literature, that only the invasive growth type gives rise to hyperplasia and this type is always concomitant with a localized form of neurofibromatosis.

Adolescent↗

Retroauricular flap: its clinical application and safety.

We report the application and safety of the retroauricular flap in 38 cases. The flap was used on the anterior auricular surface in 21 cases, in the peri-auricular region in five cases, in the region of the preauricular sideburn area in two cases, in the malar region in six cases, in the eyelid in three cases and in the intraorbital region in one case. When this flap was used in the auricular or periauricular region, the blood circulation was safe and the appearance was aesthetically good in flaps pedicled by the postauricular vessels or by the superficial temporal vessels. However, when the defect was more remote from the auricle, the blood circulation of the flaps pedicled by superficial temporal vessels, whether subcutaneous pedicle flaps or free flaps, was unstable. In some cases there was extensive or partial necrosis of the distal area of the flap. On the other hand, the free flaps pedicled by the postauricular vessels had satisfactory blood circulation, but the vessels were sometimes short, narrow and difficult to find, especially the veins. In these cases, we were obliged to use the superficial temporal vessels. A further problem is that some of the patients, especially younger women, were dissatisfied when the retroauricular flap was used in the malar region because of the reddish colour of the flap.

Adolescent↗

[Cardiotoxicity in long term treatment with cytostatics (author's transl)].

During cytostatic combination treatment with five different anti-tumor agents two female patients suffered from cardiac failure which proved fatal. This was mainly due to doxorubicine (adriamycin) and daunorubicine. In an 8-year-old patient the cumulative dose was reached after 14 months of treatment (total dose of adriamycin 420 mg/m2, of daunorubicine 280 mg/m2) and in a 7-year-old patient after 16 months (total dose of adriamycin 480 mg/m2, of daunorubicine 280 mg/m2). Cardiac failure which occurred 12 months after the onset of treatment in a 12-year-old girl (total dose of adriamycin 310 mg/m2 and of daunorubicine 280 mg/m2) could be brought under control. The cumulative dose of adriamycin should be limited to 500 mg/m2 in children without risk factors.

Bone Neoplasms↗

Genetic analysis of childhood germ cell tumors with comparative genomic hybridization.

BACKGROUND: Germ Cell Tumors (GCTs) in children and adolescents constitute a clinically and histologically heterogeneous group of tumors. Compared to GCTs in adults, the numbers of GCTs in children analyzed with cytogenetic and molecular genetic techniques is limited. However, the data available to date reveal a pattern of cytogenetic aberrations different from that in adults. Comparative genomic hybridization (CGH) is a valuable technique for the genetic profiling of tumors that allows screening for chromosomal imbalances consistent with amplification of oncogenes and loss of putative tumor suppressor genes. As CGH does not require tissue culture, it also allows analysing archival tissue samples. PATIENTS: This study focuses exclusively on GCTs in children younger than ten years of age and summarizes the genetic data of 51 tumors. Eighteen teratomas and 33 malignant GCTs were included. Primary sites were the testis (n=10), coccyx (n=13), mediastinum (n=20), ovary (n=5), CNS (n=2), and the face (n=1). METHODS: The experimental procedure includes differential enzymatic fluorescence labeling of tumor and control DNA followed by comparative hybridization to normal male chromosomes, karyotyping and computerized analysis of the fluorescence profiles. RESULTS: With the exception of one testicular and two ovarian tumors, malignant GCTs in children do not show chromosomal gain of 12p, which is characteristic of GCTs in adult patients. Irrespective of the primary site, childhood GCTs show chromosomal imbalances of chromosome 1 (loss of distal 1p, gain of 1q), deletion of 4q and 6q as well as gain of 20q at a high frequency. CONCLUSIONS: These studies will help guiding further investigations elucidating the role of putative tumor suppressor genes at e.g. 1p36 and 6q. In addition, further studies incorporated in prospective therapeutic protocols are necessary to evaluate the prognostic relevance of specific genetic aberrations.

Adolescent↗

Long-term survival in basal cell carcinoma metastatic to bone: a case report.

A total of 97 cases of metastatic basal cell carcinoma have been reported in the literature, 22 of which were metastatic to bone. To date there has been no survival following bone metastasis. A case report of significant long-term survival--over three times the expected--is presented. The treatment described is perhaps a guideline for management of basal cell carcinoma metastatic to bone, though it is presumed the basic biological nature of the tumor determines length and quality of survival.

Adult↗

Local recurrence and intracerebral spread of squamous cell carcinoma of the scalp.

This case of squamous cell carcinoma of the scalp and malar region highlights the possibilities of therapeutic failure at the excisional, reconstructive, or histopathologic stage despite the performance of the appropriate, clinically indicated procedures and customary close examination of carcinoma patients and specimens. The extent of local recurrence and rapid intracerebral spread emphasize the occasionally aggressive nature of squamous cell carcinoma of the scalp and the need for early excision.

Aged↗

Syndrome of inappropriate secretion of antidiuretic hormone in a patient affected by metastatic melanoma.

The syndrome of inappropriate secretion of antidiuretic hormone (SIADH) is characterized by hyponatraemia due to water retention resulting from the persistent release of antidiuretic hormone (vasopressin). It may occur in a variety of malignant and non-malignant conditions, in particular in association with oat cell carcinoma, pulmonary and cerebral diseases. We report the case of a male patient affected by melanoma of the right temporal region with brain metastasis who developed acute headache, drowsiness, nausea, vomiting and pathological reflexes. Clinical and laboratory investigations led us to the diagnosis of SIADH. Restriction of fluid intake obtained a good clinical improvement with normalization of laboratory alterations; after 2 months the patient experienced a new episode of SIADH which was promptly treated. As melanoma has been occasionally observed in association with SIADH it should be included in the list of tumours that can cause this particular syndrome.

Antineoplastic Agents, Alkylating↗

Extensive and fatal basal cell carcinoma: a report of three cases.

Three cases of basal cell carcinoma (BCC) with extensive invasion are described. The first two patients had meningeal and cerebral involvement with exposure of their dural meninges following full thickness skull erosion. The third patient had bilateral orbital and optic nerve involvement resulting in complete blindness. All three patients subsequently died from their disease.

Aged↗

Primary cutaneous squamous-cell carcinoma on the face: penetration to the base of the brain.

A recurrent squamous-cell carcinoma that was found clinically to have metastasized to regional lymph nodes was managed by a surgeon skilled in Moh's techniques, a plastic surgeon, and a radiotherapist in a premeditated plan. The malignancy was further found to have extended to the base of the brain. As much surgery as was deemed feasible, still short of complete ablation of the malignancy, was performed. Radiotherapy to the neck prior to radical lymphadenectomy and to the base of the brain subsequently was administered. After one year of follow-up, the patient is well, though prognosis is guarded.

Brain Neoplasms↗

Metastatic basal cell carcinoma.

A case of metastasizing basal cell carcinoma is presented. Although primary surgical excision appeared complete, local recurrence continued over the following 5 years terminating in metastases to lungs, kidneys, bones and lymph nodes.

Bone Neoplasms↗