We describe a 40-year-old male who presented with sarcoidal granulomas not only at the entry site of an industrial lubricating oil containing silicone in the right thumb, but also in a regional lymph node and at the e...We describe a 40-year-old male who presented with sarcoidal granulomas not only at the entry site of an industrial lubricating oil containing silicone in the right thumb, but also in a regional lymph node and at the entry points of venepuncture in both forearms. Laboratory tests and chest X-ray showed no evidence of sarcoidosis.展开更多
Malignant melanoma of the skin preferentially metastasises viathe lymphatic system. Novel molecular biomarkers, which are involved in malignant transformation, proliferation, angiogenesis and lymphangiogenesis, are cu...Malignant melanoma of the skin preferentially metastasises viathe lymphatic system. Novel molecular biomarkers, which are involved in malignant transformation, proliferation, angiogenesis and lymphangiogenesis, are currently under investigation to elucidate the risk for lymph node metastasis. To this end, the vascular endothelial growth factors VEGF- C and VEGF- D have been identified to promote lymphangiogenesis and lymphatic spread through activation of its receptor, Vascular endothelial growth factor receptor- 3 (VEGFR- 3). Prompted by this assumption, we estimated the degree of lymphangiogenesis by semiquantitative immunohistochemical analysis of the expression of VEGFR- 3 and the pan vascular marker CD31 in primary cutaneous melanoma (n= 26) and correlated these findings with the sentinel lymph node (SLN) status. The cohort was selected for matched prognostic markers in SLN- positive and SLN- negative patients. In contrast to other studies,we observed an inverse correlation between expression of these markers with lymph node metastases. Additionally, no difference between intratumoral versus peritumoral CD31- orVEGFR- 3 expression on blood vessels versus lymphatic capillaries could be detected. Interestingly, VEGFR- 3 upregulation was not restrained to vascular structures but also appeared on tumor cells. In summary, in our series VEGFR- 3CD31 immunohistochemical staining of primary melanoma does not serve as a valid marker to predict lymph node involvement. As lymphatic spread is a complex, multi- step process, several different biomarkers have to be combined to define new prognostic subgroups in cutaneous melanoma.展开更多
Objectives: Our aims were (1) to compare the respective ability of ultrasonography and palpation to detect nodal metastasis during initial staging and follow-up in patients having melanomas and (2) to assess, we belie...Objectives: Our aims were (1) to compare the respective ability of ultrasonography and palpation to detect nodal metastasis during initial staging and follow-up in patients having melanomas and (2) to assess, we believe for the first time, which ultrasound criteria should be used to define metastasis in cases of cutaneous or mucosal melanoma. Design: Prospective single-center study. Nodal metastasis was confirmed by histopathologic evaluation. Setting: Dermatology and radiology departments of a university hospital. Patients: A total of 160 new consecutive patients with stage I to stage III melanoma. Intervention: Experienced operators independently performed 391 paired palpation and ultrasonographic examinations. Main Outcome Measures: Firm enlarged nodes found on palpation were considered metastatic. On ultrasonographic examination, circular or oval hypoechoic lymph nodes lacking hyperechoic hila were considered metastatic (stringent criteria). Nodes with 2 or fewer of these patterns and other published signs of metastasis (ie, intranodal nodular hypoechoic focus and irregularity of the node margin) were considered suspicious. Results: Over the 6-year study period 33 patients developed nodal metastasis. For palpation and ultrasonography using the stringent criteria, respectively, sensitivity was 41.5% (95% confidence interval 95% CI , 29.6-53.5) and 76.9% (95% CI, 66.7% -87.2% ) (P < .001)and specificity was 95.7% (95% CI, 93.5% -97.9% ) and 98.4% (95% CI, 97.1% -99.8% ) (P < .05). Including ultrasonographically suspicious lymph nodes significantly lowered specificity (86.2% 95% CI, 82.5-89.9 ) (P < .05) without improving sensitivity. Previous lymphadenectomy had little impact on ultrasonographic findings. Conclusion: Ultrasonography using stringent criteria of nodal metastasis, which are easy to identify and reliable, is superior to palpation for early detection of regional lymph node metastases of melanoma.展开更多
文摘We describe a 40-year-old male who presented with sarcoidal granulomas not only at the entry site of an industrial lubricating oil containing silicone in the right thumb, but also in a regional lymph node and at the entry points of venepuncture in both forearms. Laboratory tests and chest X-ray showed no evidence of sarcoidosis.
文摘Malignant melanoma of the skin preferentially metastasises viathe lymphatic system. Novel molecular biomarkers, which are involved in malignant transformation, proliferation, angiogenesis and lymphangiogenesis, are currently under investigation to elucidate the risk for lymph node metastasis. To this end, the vascular endothelial growth factors VEGF- C and VEGF- D have been identified to promote lymphangiogenesis and lymphatic spread through activation of its receptor, Vascular endothelial growth factor receptor- 3 (VEGFR- 3). Prompted by this assumption, we estimated the degree of lymphangiogenesis by semiquantitative immunohistochemical analysis of the expression of VEGFR- 3 and the pan vascular marker CD31 in primary cutaneous melanoma (n= 26) and correlated these findings with the sentinel lymph node (SLN) status. The cohort was selected for matched prognostic markers in SLN- positive and SLN- negative patients. In contrast to other studies,we observed an inverse correlation between expression of these markers with lymph node metastases. Additionally, no difference between intratumoral versus peritumoral CD31- orVEGFR- 3 expression on blood vessels versus lymphatic capillaries could be detected. Interestingly, VEGFR- 3 upregulation was not restrained to vascular structures but also appeared on tumor cells. In summary, in our series VEGFR- 3CD31 immunohistochemical staining of primary melanoma does not serve as a valid marker to predict lymph node involvement. As lymphatic spread is a complex, multi- step process, several different biomarkers have to be combined to define new prognostic subgroups in cutaneous melanoma.
文摘Objectives: Our aims were (1) to compare the respective ability of ultrasonography and palpation to detect nodal metastasis during initial staging and follow-up in patients having melanomas and (2) to assess, we believe for the first time, which ultrasound criteria should be used to define metastasis in cases of cutaneous or mucosal melanoma. Design: Prospective single-center study. Nodal metastasis was confirmed by histopathologic evaluation. Setting: Dermatology and radiology departments of a university hospital. Patients: A total of 160 new consecutive patients with stage I to stage III melanoma. Intervention: Experienced operators independently performed 391 paired palpation and ultrasonographic examinations. Main Outcome Measures: Firm enlarged nodes found on palpation were considered metastatic. On ultrasonographic examination, circular or oval hypoechoic lymph nodes lacking hyperechoic hila were considered metastatic (stringent criteria). Nodes with 2 or fewer of these patterns and other published signs of metastasis (ie, intranodal nodular hypoechoic focus and irregularity of the node margin) were considered suspicious. Results: Over the 6-year study period 33 patients developed nodal metastasis. For palpation and ultrasonography using the stringent criteria, respectively, sensitivity was 41.5% (95% confidence interval 95% CI , 29.6-53.5) and 76.9% (95% CI, 66.7% -87.2% ) (P < .001)and specificity was 95.7% (95% CI, 93.5% -97.9% ) and 98.4% (95% CI, 97.1% -99.8% ) (P < .05). Including ultrasonographically suspicious lymph nodes significantly lowered specificity (86.2% 95% CI, 82.5-89.9 ) (P < .05) without improving sensitivity. Previous lymphadenectomy had little impact on ultrasonographic findings. Conclusion: Ultrasonography using stringent criteria of nodal metastasis, which are easy to identify and reliable, is superior to palpation for early detection of regional lymph node metastases of melanoma.
