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Notes: Zusammenfassung. Wir berichten über den Fall einer 15jährigen Patientin vom Typus verrucosus des Thomson-Syndroms. Initiale poikilodermatische Hautveränderungen an den Wangenpartien manifestierten sich im 3. Lebensmonat. Nachfolgend kam es zur schnellen Progression der typischen Hautveränderungen auf das gesamte Integument. Anhand dieses Falles wird unter gleichzeitiger Literaturberücksichtigung die klinische Heterogenität dieses Krankheitsbildes illustriert. Über assoziierte neurologische Symptome, wie in unserer Kasuistik, ist bislang nur außerordentlich selten berichtet worden.

Notes: Rituximab, a chimeric anti-CD20 monoclonal antibody, has been approved for systemic treatment of relapsed or refractory CD20-positive B-cell non-Hodgkin’s lymphoma. As cutaneous B-cell lymphoma (CBCL) also expresses the CD20 molecule, three patients with histologically and immunohistochemically confirmed CBCL without systemic involvement were treated with low-dose intralesional rituximab in a pilot study. Single doses applied ranged from 10 to 30 mg per lesion, according to lesion extent, with a cumulative dose of up to 350 mg. Injections were given two or three times weekly for 3–5 weeks, with a second cycle after 6 weeks in one patient with incomplete remission. Complete and lasting remission was achieved in each patient; this has persisted for up to more than 1 year. The observed adverse events were of grade 1 severity. Results suggest that intralesional rituximab may be a safe and effective new therapy modality for CBCL.

Notes: Background  The status of the sentinel lymph node (SLN) is an important prognostic factor in patients with cutaneous melanoma. Reverse transcription–polymerase chain reaction (RT–PCR) has been used as a sensitive means of detecting tumour cells in SLNs.Objectives  To determine whether RT–PCR analysis of the SLN using both the central and the peripheral slices is more sensitive than molecular analysis of the central slice only.Methods  Eighty-three SLNs from 59 patients with primary cutaneous melanoma were identified by SLN mapping. All SLNs were bisected along their longitudinal axis to produce two equal halves. One half was used for histology and immunohistochemistry, and the other was analysed by RT–PCR for tyrosinase and MelanA. Parallel to the longitudinal axis, one central slice (approximately 2 mm in thickness) was cut manually. This central slice was used for our standard RT–PCR protocol. In the current study, up to eight additional peripheral slices (each approximately 2 mm in thickness) were cut parallel to the existing cut surface. These peripheral slices were analysed by additional RT–PCR.Results  Standard RT–PCR of the central slice yielded positive results in 34 of 59 patients (57%). Additional RT–PCR of peripheral slices demonstrated positive findings in six additional patients (10%) who were initially negative by standard RT–PCR of the central slice. In detail, seven of those 34 patients positive by standard RT–PCR of the central slice had positive histological findings. In each of these seven patients, RT–PCR was positive both in the central slice as well as in the peripheral slices. The remaining 27 patients with positive RT–PCR results of the central slice showed negative histological findings. Only nine (33%) of these 27 patients had a positive RT–PCR also in the peripheral slices. Finally, all 25 patients with negative RT–PCR results in the central slice showed negative histological findings. Six of these patients (24%) revealed positive RT–PCR results on the analysis of peripheral slices. However, three of these patients expressed only MelanA but not tyrosinase. Thirty lymph nodes from 24 nonmelanoma patients served as negative controls for RT–PCR. In three of these 24 patients (13%) expression of MelanA but not tyrosinase was detected by RT–PCR.Conclusions  Molecular analysis of peripheral slices yielded six additional patients (10%) positive by RT–PCR who were initially negative by standard RT–PCR of the central slice. However, three of these six patients were found to express only MelanA but not tyrosinase. As MelanA expression was also found in 13% of control lymph nodes, positive MelanA expression alone in SLNs of melanoma patients requires cautious interpretation in order to avoid false-positive findings. Thus, additional molecular processing of peripheral slices did not significantly increase the number of patients with RT–PCR-positive SLNs.

Notes: Background Tyrosinase reverse transcription–polymerase chain reaction (RT–PCR) has been shown to be highly sensitive in detecting tumour cells in melanoma patients. Objective To assess whether the detection of minimal residual disease by RT–PCR is improved by concomitant analysis of sentinel lymph nodes (SLNs), bone marrow (BM) and peripheral blood (PB) in patients with primary melanoma. Methods Thirty-five SLNs, 41 BM samples and 26 PB specimens from 26 patients with primary cutaneous melanoma (tumour thickness ≥ 0·75 mm) were examined by nested RT–PCR for tyrosinase and Melan-A. SLNs and BM samples were also analysed by histopathology. RT–PCR findings were related to tumour thickness of the primary melanoma. Results Overall, melanoma cells were detected by RT–PCR in 13 of 26 patients (50%). Seven patients had positive RT–PCR results in their SLNs (27%), including all patients (n = 4) with histologically positive SLNs, two patients had positive findings in their BM exclusively detected by RT–PCR (8%) and six patients in PB (23%). The presence of tumour cells detected by RT–PCR in SLNs was not related to the presence of melanoma cells in BM and/or PB. The incidence of RT–PCR-positive SLNs was significantly associated with greater tumour thickness (P = 0·004). Both patients with positive RT–PCR findings in their BM had a large tumour thickness (≥ 2 mm). No association between positive RT–PCR findings in PB and greater tumour thickness was observed. Conclusions RT–PCR-positive SLNs were strongly associated with greater tumour thickness, underlining the prognostic significance of SLN positivity. Similar to certain epithelial malignancies, molecular investigation of the BM might provide complementary prognostic information in the early stages of melanoma. In contrast, no association between positive RT–PCR results in PB and increasing tumour thickness was found, implying that RT–PCR findings in PB are of doubtful clinical relevance in primary melanoma.