RESUMEN
This article reviews the current status of information on external male genital injuries, focusing on cause, diagnostic and therapeutic management of this uncommon entity. Because of the high risk of infection and the major importance of preserving fertility, male genital injuries represent a serious urological disorder that demands immediate urological treatment. The diagnostic procedure classically consists of taking a history and inspecting the wound; this provides enough diagnostic information for the correct choice of conservative or surgical treatment. In most cases open injuries of the genitalia require surgical exploration to determine the extent of possible scrotal, testicular, epididymal, cavernosal or urethral damage, to debride nonviable superficial or deep tissue, to drain existing haematomas or to control active bleeding. Furthermore, the correct therapeutic approach is crucial for preserving fertility and penile erection. In cases where bilateral ablation is necessary, measures to preserve sperm, e.g. testicular or microsurgical sperm extraction, or squeezing the ductus during orchidectomy, must be considered.
Asunto(s)
Genitales Masculinos/lesiones , Animales , Mordeduras y Picaduras/diagnóstico , Mordeduras y Picaduras/terapia , Quemaduras/diagnóstico , Quemaduras/terapia , Humanos , Masculino , Conducta Autodestructiva/diagnóstico , Conducta Autodestructiva/terapia , Heridas por Arma de Fuego/diagnóstico , Heridas por Arma de Fuego/terapia , Heridas no Penetrantes/diagnóstico , Heridas no Penetrantes/terapia , Heridas Punzantes/diagnóstico , Heridas Punzantes/terapiaRESUMEN
A female patient presented with acral scleroderma, Sjögren syndrome, antibodies specific for primary biliary cirrhosis and clinical as well as histological features of lichen planus and subacute lupus erythematosus. In addition an euthyroid Hashimoto thyroiditis was found. Her findings correspond to type II of the multiple autoimmune syndrome (MAS) and can be described as an association of Reynolds syndrome and the lupus erythematosus/lichen planus-overlap syndrome.
Asunto(s)
Enfermedades Autoinmunes/patología , Liquen Plano/patología , Cirrosis Hepática Biliar/patología , Lupus Eritematoso Cutáneo/patología , Esclerodermia Sistémica/patología , Síndrome de Sjögren/patología , Diagnóstico Diferencial , Femenino , Humanos , Persona de Mediana Edad , SíndromeRESUMEN
A 61 year old male patient suffering from psoriasis vulgaris developed a severe skin reaction with toxic myelosuppression three days after administration of 20 mg methotrexate (MTX) p.o. per week and concomitant 100 mg acetylic salicylic acid (ASA) per day. The skin lesions simulated Stevens-Johnson syndrome with ulcerations of the oral mucosa and erythema multiforme-like target lesions. The histology of the epidermis resembled an acute graft-versus-host reaction. The increased toxic effect of MTX on keratinocytes in our patient was most likely caused by a lowered plasma binding capacity and reduced renal excretion of MTX due to concomitant administration of ASA. Thus in the treatment of severe forms of psoriasis with MTX, the combined administration of drugs aggravating MTX toxicity, particularly of ASA, should be carefully considered, due to the increased toxicity and risk of severe skin reactions.
Asunto(s)
Erupciones por Medicamentos/diagnóstico , Erupciones por Medicamentos/etiología , Metotrexato/efectos adversos , Psoriasis/tratamiento farmacológico , Síndrome de Stevens-Johnson/inducido químicamente , Síndrome de Stevens-Johnson/diagnóstico , Diagnóstico Diferencial , Interacciones Farmacológicas , Quimioterapia Combinada , Enfermedad Injerto contra Huésped/diagnóstico , Humanos , Masculino , Metotrexato/administración & dosificación , Persona de Mediana Edad , Psoriasis/diagnóstico , Índice de Severidad de la EnfermedadRESUMEN
PURPOSE: To assess the diagnostic value of fluor-18-fluorodeoxyglucose positron emission tomography (FDG-PET) in screening for melanoma metastases. MATERIAL AND METHODS: The case records of 94 melanoma patients who had been examined by whole-body FDG-PET between 1995 and 1999 were evaluated retrospectively. Forty patients showed evidence of lymphogenous and 42 of hematogenous metastasis. The maximal interval between PET and the diagnostic procedure under comparison was 2 weeks. Confirmation of the findings was based on histology or the clinical or radiological course. RESULTS: In 24 patients, all diagnostic examinations including CT had been performed within 2 weeks from PET. In no case did PET change the staging. In 13 patients, PET agreed with morphological diagnosis in the number of metastatically invaded organs. This included 3 patients without metastases. The estimated number of organs invaded by metastases was higher with PET in 5 patients and higher with morphological imaging techniques in 6 patients. Among the PET findings with higher or equivocal counts of organs with metastases there were 2 confirmed false-positive findings. CONCLUSION: In a selected patient population, FDG-PET was found to be inferior to CT for diagnosing lung and liver metastases. The supplementary use of FDG-PET is not generally of value once metastasis has been established.
Asunto(s)
Diagnóstico por Imagen , Fluorodesoxiglucosa F18 , Melanoma/secundario , Radiofármacos , Tomografía Computarizada de Emisión , Abdomen/diagnóstico por imagen , Adolescente , Adulto , Anciano , Reacciones Falso Positivas , Femenino , Estudios de Seguimiento , Humanos , Neoplasias Hepáticas/diagnóstico por imagen , Neoplasias Hepáticas/patología , Neoplasias Hepáticas/secundario , Neoplasias Pulmonares/diagnóstico por imagen , Neoplasias Pulmonares/patología , Neoplasias Pulmonares/secundario , Metástasis Linfática/diagnóstico por imagen , Imagen por Resonancia Magnética , Masculino , Tamizaje Masivo , Melanoma/diagnóstico por imagen , Melanoma/patología , Persona de Mediana Edad , Estadificación de Neoplasias , Células Neoplásicas Circulantes/patología , Estudios Retrospectivos , Neoplasias Cutáneas/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Ultrasonografía , Irradiación Corporal TotalAsunto(s)
Glomerulonefritis Membranosa/complicaciones , Granuloma de Células Plasmáticas/complicaciones , Enfermedades de la Piel/complicaciones , Antiinflamatorios/uso terapéutico , Preescolar , Glomerulonefritis Membranosa/tratamiento farmacológico , Glomerulonefritis Membranosa/patología , Granuloma de Células Plasmáticas/tratamiento farmacológico , Granuloma de Células Plasmáticas/patología , Humanos , Inmunosupresores/uso terapéutico , Masculino , Ácido Micofenólico/análogos & derivados , Ácido Micofenólico/uso terapéutico , Prednisona/uso terapéutico , Enfermedades de la Piel/tratamiento farmacológico , Enfermedades de la Piel/patologíaRESUMEN
The diagnostic and therapeutic impact and the cost-effectiveness of positron emission tomography (PET) using 18F-fluorodeoxyglucose (FDG) will depend on the role for which the tests are used. In 68 patients with advanced malignant melanoma, original sets of FDG-PET images from various institutes were compared with findings obtained by ultrasonography, conventional radiology, computed tomography (CT) and magnetic resonance imaging. In 22 patients, all examinations were undertaken within 2 weeks and strategies of staging were analysed. In 46 patients, only some of these examinations were performed within this time period, and comparison of methods was restricted to the examined organs. The occurrence of metastasis, without specifying the number of foci, was detected by either conventional staging with CT or by PET in 20 of 22 patients. None of these patients were up- or down-staged by FDG-PET compared with CT staging. In the 68 patients as a whole, FDG-PET detected fewer pulmonary and hepatic metastases and fewer cerebral foci, but more lymph node and bone metastases than conventional radiology or CT. For the detection of lymph node or skeletal metastases, false-positive FDG-PET findings were taken into account when compared with follow-up data. In advanced melanoma, FDG-PET did not influence the pattern of subsequent diagnostic testing. Thus, indications for FDG-PET include pre-metastatic melanoma, localized lymph node metastases and monitoring of the response to treatment.
Asunto(s)
Fluorodesoxiglucosa F18 , Melanoma/diagnóstico por imagen , Radiofármacos , Adolescente , Adulto , Neoplasias Óseas/diagnóstico por imagen , Neoplasias Óseas/secundario , Neoplasias Encefálicas/diagnóstico por imagen , Neoplasias Encefálicas/secundario , Femenino , Humanos , Metástasis Linfática/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Tomografía Computarizada de Emisión , Tomografía Computarizada por Rayos X , UltrasonografíaRESUMEN
Clinical and histopathological findings of 34 cases of desmoplastic malignant melanoma (DMM) are summarized and compared to the literature. DMM develop mostly in sun damaged skin of elderly patients, they are rare and often nonpigmented tumors that are difficult to diagnose clinically. In all cases the tumor parameters showed level IV or V melanomas (level IV: 55.9%, level IV-V: 14.7%, level V: 29.4%) and the tumor thickness measured 3.85 mm +/- 2.31 mm (1.0-11.0 mm). In 22 cases, the follow-up time was between 2 and 7 years. Local recurrences were observed in 7 ( = 31.8%) patients, metastases in 4 ( = 18.2%) and tumor-related deaths in 3. The prognosis for our patients seems to be slightly better than that described in the literature. The main reason is an improved histological diagnosis of this special type of melanoma. Using immunohistochemical staining with anti-S100 antibody it is possible to establish the melanocytic nature of these fibrotic spindle cell tumors earlier that is, in small initial biopsies, and tumor margins can be defined more accurately. As a consequence, surgery is done earlier and is more likely to be curative.
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Neoplasias Faciales/patología , Melanoma/patología , Neoplasias Cutáneas/patología , Anciano , Anciano de 80 o más Años , Procedimientos Quirúrgicos Dermatologicos , Diagnóstico Diferencial , Neoplasias Faciales/mortalidad , Neoplasias Faciales/cirugía , Femenino , Estudios de Seguimiento , Humanos , Masculino , Melanoma/mortalidad , Melanoma/cirugía , Persona de Mediana Edad , Estadificación de Neoplasias , Piel/patología , Neoplasias Cutáneas/mortalidad , Neoplasias Cutáneas/cirugía , Tasa de SupervivenciaRESUMEN
Mutation in the p53 tumor suppressor gene is the most common genetic alteration in human cancer. As in mutant p53 the protein is stabilised and the half-life is extended, it becomes detectable by immunohistological staining. p53 immunoreactivity thus seems to be a potential biomarker for the assessment of the oncogenic potential of malignant melanomas. In 103 tissue sections of primary and metastatic malignant melanomas of the head and neck detectable levels of p53 were only found in 3 of the primary tumors and in none of the metastases. At the same time the proliferation status of the malignant melanoma lesions was determined using the cell cycle specific antibody PCNA. 55 primary and metastatic tumors were stained with a PCNA-MAb to determine the proliferation activity of the tumors. The results of our immunohistochemical investigation suggest that immunoreactivity of p53 cannot be used to determine the malignant potential of melanomas in the head and neck. PCNA staining showed that the majority of the tumors and metastases were proliferating rapidly.
Asunto(s)
Expresión Génica , Neoplasias de Cabeza y Cuello/química , Melanoma/química , Antígeno Nuclear de Célula en Proliferación/análisis , Proteína p53 Supresora de Tumor/análisis , Anticuerpos Monoclonales , División Celular , Neoplasias de Cabeza y Cuello/patología , Humanos , Inmunohistoquímica , Melanoma/patologíaRESUMEN
Nine medical centres with different practices in elective lymph node dissection (ELND) but comparable standards regarding diagnosis, excision of the primary tumour, classification, and follow-up, have collected their data on 3616 patients with primary melanoma of the skin (tumour category pT 2 to pT 4a, N 0, M 0 [UICC 1987] with the aim of producing an unbiased analysis of the prognostic benefit of ELND. The multivariate risk analysis (Cox's proportional hazard model) revealed tumour thickness (Breslow or alternative pT categories), sex, anatomic site of the primary tumour, and ELND therapy ("yes" or "no") as independent prognostic factors. Observed survival curves (Kaplan-Meier) show a significant difference of prognosis with regard to ELND therapy in the following risk groups: women with melanomas over 2.5 to 4 mm thick on head, neck, thorax, and in acral locations; men with melanomas over 1.5 to 4 mm thick on head, neck, thorax, and in acral locations; and finally men with melanomas over 2.5 to 4 mm thick on abdomen and extremities. Further investigations and the discovery of additional prognostic factors would help in more precisely formulation of guidelines for ELND.
Asunto(s)
Escisión del Ganglio Linfático , Melanoma/cirugía , Neoplasias Cutáneas/cirugía , Adulto , Anciano , Supervivencia sin Enfermedad , Femenino , Estudios de Seguimiento , Humanos , Masculino , Melanoma/mortalidad , Melanoma/patología , Persona de Mediana Edad , Estadificación de Neoplasias , Modelos de Riesgos Proporcionales , Estudios Retrospectivos , Neoplasias Cutáneas/mortalidad , Neoplasias Cutáneas/patología , Análisis de Supervivencia , Tasa de SupervivenciaRESUMEN
Even today, the prognosis of acrallentiginous melanoma (ALM) remains a controversial topic. We present a large case study including all known factors relevant for prognosis. 113 ALMs in 3616 melanoma patients were paired as precisely as possible with their twins, i.e. with 113 superficial spreading melanomas (SSM) from a group of 619 SSMs with high-risk location. The ALMs and SSMs were equivalent in tumor thickness, patient gender and mode of treatment. The follow-up period was for at least 5 years. The 5-year Kaplan-Meier survival curve in both groups are identical. The poor prognosis often ascribed to ALM results from the prognostic factor location. ALM should therefore be regarded as acral localized melanoma.
Asunto(s)
Melanoma/patología , Neoplasias Cutáneas/patología , Anciano , Causas de Muerte , Femenino , Estudios de Seguimiento , Humanos , Masculino , Análisis por Apareamiento , Melanoma/clasificación , Melanoma/mortalidad , Melanoma/terapia , Índice Mitótico , Piel/patología , Neoplasias Cutáneas/clasificación , Neoplasias Cutáneas/mortalidad , Neoplasias Cutáneas/terapia , Análisis de Supervivencia , Tasa de SupervivenciaRESUMEN
Since the immune system plays an important role in the rejection of tumours, current tumour therapy includes immunostimulation. This can be done by interleukin 2 (IL-2), which activates T and killer cells and induces lysis of the tumour. Because the intravenous application of IL-2 may have serious side effects, we treated two patients with peritumoral injections in a pilot study. Both patients suffered from multiple cutaneous metastases of melanoma. A total of 31 and 39 x 10(6) IU recombinant IL-2 (Proleukin) respectively was injected in increasing concentrations in one metastasis of each patient. Histologically, almost complete necrosis of the tumour was induced. In comparison with the control specimen, the T-cell-rich infiltrate increased intra- and, in particular, peritumorally. While the ratio of helper to suppressor T cells remained unchanged, the proportions of NK cells, monocytes/macrophages and IL-2-receptor-bearing cells increased. This reaction was restricted to treated metastases. No clinical side effects or laboratory changes were registered apart from local erythema and swelling.
Asunto(s)
Interleucina-2/administración & dosificación , Melanoma/terapia , Neoplasias Cutáneas/terapia , Anciano , Humanos , Inyecciones Intralesiones , Interleucina-2/efectos adversos , Recuento de Linfocitos/efectos de los fármacos , Subgrupos Linfocitarios/efectos de los fármacos , Subgrupos Linfocitarios/inmunología , Masculino , Melanoma/inmunología , Melanoma/patología , Persona de Mediana Edad , Proyectos Piloto , Proteínas Recombinantes/administración & dosificación , Proteínas Recombinantes/efectos adversos , Piel/inmunología , Piel/patología , Neoplasias Cutáneas/inmunología , Neoplasias Cutáneas/patologíaRESUMEN
BACKGROUND: The benefit of elective lymph node dissection (ELND) for the treatment of the nonmetastasized malignant melanoma has been assessed differently until today. METHODS: Nine medical centers with a different ELND practice but comparable standards regarding diagnosis, excision of the primary tumors, classification, and follow-up, have collected their data (primarily ascertained prospectively) of 3616 patients of the tumor categories pT2 to pT4N0M0 to produce an unbiased analysis of the prognostic benefit of ELND, and to find the indications for its application. The data are based on patients 70 years of age and younger with a primary melanoma of the skin, who have been followed for at least 4 years (median, 9.6 years). The stratification (according to pT category [alternatively, tumor thickness], sex, anatomic site) was in accordance with the results of the multivariate risk analysis (Cox hazard model). Imbalances of other criteria such as ulceration, type, and age were excluded by chi-square tests of the individual strata. The results are based on the observed survival rates according to Kaplan-Meier analysis of the different strata. RESULTS: A prognostic benefit of the ELND group (improvement of the 5-year survival rate of about 20%) can be claimed for male patients with axial and acral melanomas (excluding lentigo maligna melanoma [LMM] and ulcerated tumors) of the categories pT3a up to pT4a (tumor thickness of > 1.5-4.5 mm, respectively) (P < 0.001). As to the rest of the nonulcerated tumors of male patients, only those of the categories pT3b and 4a benefited from ELND (P < 0.01). A benefit from ELND for women was statistically verified (improvement of the 5-year survival rate of about 5%-10%) only for the subgroup with a tumor thickness > 2.5-5 mm, excluding LMM) (P = 0.016). CONCLUSIONS: This retrospective study strongly suggests the efficacy of ELND in subgroups of melanoma patients.
Asunto(s)
Escisión del Ganglio Linfático , Melanoma/cirugía , Neoplasias Cutáneas/cirugía , Adulto , Anciano , Femenino , Humanos , Masculino , Melanoma/mortalidad , Melanoma/patología , Persona de Mediana Edad , Estadificación de Neoplasias , Pronóstico , Modelos de Riesgos Proporcionales , Estudios Retrospectivos , Neoplasias Cutáneas/mortalidad , Neoplasias Cutáneas/patología , Tasa de SupervivenciaRESUMEN
A 35-year-old female patient suffered from angiolymphoid hyperplasia with eosinophilia for 9 years, with multiple, exophytic tumours on her left pinna and the surrounding skin. Systemic treatment with gamma interferon and glucocorticoids, intralesional injections of glucocorticoids and argon laser therapy had no effect. After the tumours had been pared away by electrocautery the patient was free of symptoms for 1 year and then developed a small local recurrence. Recurrences are common in angiolymphoid hyperplasia with eosinophilia. Malignant transformation has not been observed. We therefore regard non-radical surgery as the therapy of choice.
Asunto(s)
Hiperplasia Angiolinfoide con Eosinofilia/diagnóstico , Enfermedades del Oído/diagnóstico , Dermatosis Facial/diagnóstico , Anciano , Hiperplasia Angiolinfoide con Eosinofilia/patología , Hiperplasia Angiolinfoide con Eosinofilia/cirugía , Biopsia , Enfermedades del Oído/patología , Enfermedades del Oído/cirugía , Oído Externo/patología , Electrocoagulación , Dermatosis Facial/patología , Dermatosis Facial/cirugía , Femenino , Humanos , Piel/patologíaRESUMEN
The validity of current staging systems for malignant melanoma was analyzed in a prospective study on 220 patients with extremity melanoma. Patients were followed 2 to 9 years after a wide excision of the primary, regional cytostatic perfusion and dissection of regional lymph nodes. The "original three-stage" system yielded statistically significant differentiation, but with a distinct preference for Stage I. The classification into IA/B, and IIIA/B/C according to the M.D. Anderson system does not distribute the patients into significantly different tumor stages. Using the American Joint Committee of Cancer Staging and End Results Reposting (AJCC) system, 40 patients were classified as Stage I, 95 as Stage II, 53 as Stage III, and 32 patients as Stage IV. The 5-year survival rate was 96% in Stage I, 90% in Stage II, 68% in Stage III, and 30% in Stage IV. According to the UICC staging system there was a numerical preference of Stage II and III. The differentiation of Stage I and II was not significant. It is the authors' opinion that the AJCC staging system allows the best differentiation of melanoma patients into tumor stages that are evenly distributed and significant for prognoses.
Asunto(s)
Melanoma/patología , Estadificación de Neoplasias/métodos , Neoplasias Cutáneas/patología , Adulto , Extremidades , Femenino , Humanos , Escisión del Ganglio Linfático , Metástasis Linfática , Masculino , Melanoma/clasificación , Melanoma/cirugía , Persona de Mediana Edad , Pronóstico , Neoplasias Cutáneas/clasificación , Neoplasias Cutáneas/cirugía , Análisis de SupervivenciaRESUMEN
We report on a 20-year-old man and a 14-year-old girl showing multiple basaloid follicular hemartomas on face and upper back. Both patients were members of a family with Gorlin-Goltz syndrome.
Asunto(s)
Síndrome del Nevo Basocelular/genética , Carcinoma Basocelular/genética , Neoplasias Faciales/genética , Hamartoma/genética , Neoplasias Primarias Múltiples/genética , Neoplasias Cutáneas/genética , Adolescente , Síndrome del Nevo Basocelular/patología , Neoplasias Faciales/patología , Femenino , Hamartoma/patología , Humanos , Neoplasias Primarias Múltiples/patología , Piel/patología , Neoplasias Cutáneas/patologíaRESUMEN
A prospective randomized study was carried out to evaluate the effectiveness of additional regional cytostatic perfusion of the extremities in patients with malignant melanoma. In a control group (n = 54), the tumors were widely excised, and regional lymph nodes were dissected. The patients in the perfusion group (n = 53) received additional hyperthermic (42 degrees C) perfusion with Melphalan. The disease-free survival time was chosen as the criterion for evaluation. An intermediate analysis revealed a highly significant difference between the 2 groups (21 recurrences in the control group and 4 recurrences in the perfusion group, p less than 0.001). Therefore, the study was discontinued prematurely. In an analysis of the data performed after a median observation time of 5 years and 11 months, 26 recurrences were diagnosed in the control group, whereas 6 recurrences were noted in the perfusion group (p less than 0.001). The retrospective breakdown into different risk groups according to tumor thickness also demonstrates a significant difference. For patients with a primary tumor of 1.5-3.0-mm in thickness, 2 of 25 in the perfusion group and 10 of 25 in the control group have relapsed. For those with a primary tumor of greater than 3.0-mm in thickness, 4 of 28 in the perfusion group and 16 of 29 in the control group have relapsed. Eleven patients in the control group and 3 patients in the perfusion group have died due to metastatic spread of the melanoma (p less than 0.01). The results most clearly demonstrate the benefits of additional hyperthermic cytostatic perfusion.