Clinical Follow-up of Atypical Spitzoid Tumors Analyzed by Fluorescence In Situ Hybridization.

Many neoplasms with spitzoid features remain enigmatic, especially those with intermediate grade features or "atypical spitzoid tumors" (ASTs). Fluorescence in situ hybridization (FISH) has emerged as a complementary technique to conventional microscopy, with certain chromosomal patterns conveying diagnostic information. In this study, we examined 36 ASTs analyzed by FISH for specific abnormalities in chromosomes 6, 9, and 11. Aberrations were detected in 11 cases, 7 of which met FISH criteria for spitzoid melanoma. These had homozygous deletion of 9p21, partial deletion of 11q13, gain of 6p25, and gain of 11q13. All 3 patients with positive sentinel lymph nodes, including one with progression beyond the sentinel lymph node, had homozygous deletion of chromosome 9p21, but there were no deaths in an average of 28 months of follow-up of these cases. Other aberrations in the chromosomal pattern of ASTs were heterozygous deletion of 9p21, partial deletion of 6p23, and tetraploidy. We found that ASTs, including those eventually diagnosed as spitzoid melanoma, had a more indolent course in our cohort than conventional malignant melanoma. Moreover, the addition of FISH results led to a more definitive diagnosis in 7 cases, 4 of which had abnormalities on FISH consistent with spitzoid melanoma.

The impact of biopsy technique on upstaging, residual disease, and outcome in cutaneous melanoma.

BACKGROUND: After skin biopsy of malignant melanoma, the findings in the subsequent wide local excision (WLE) sometimes result in upgrading of the T-category. Herein, we examine the influence of biopsy technique on residual disease in melanoma WLE specimens and on upstaging. METHODS: We performed a retrospective review of data from malignant melanoma patients who underwent sentinel lymph node biopsy between 1997 and 2010. RESULTS: A total of 609 patients were biopsied by shave (51%), punch (19%), and excision (30%). Residual disease was seen in 240 patients (39%) at WLE, of whom 60% had undergone shave biopsy. Fifty-nine patients had a T-category upgrade after WLE (10% of all patients); 64% were sampled by shave. Seven percent of patients with a T-category upgrade had negative margins initially. Positive biopsy margin and greater thickness predicted T-category upgrade. CONCLUSIONS: Partial biopsy for melanoma resulted in more residual disease at WLE and a higher rate of T-category upgrade. Moreover, the presence of negative margins at biopsy did not ensure lack of residual disease.

Prostate brachytherapy seed migration to the left testicular vein.

PURPOSE: Prostate brachytherapy seeds may detach from their initial insertion sites and migrate to lungs, heart, coronary artery, liver, kidney, and vertebral venous plexus. The authors present the left testicular vein as additional site of seed embolization. METHODS AND MATERIALS: The authors report a 68-year-old man with seed migration to the left testicular vein shortly after brachytherapeutic procedure. All imaging procedures obtained after the transperineal seed implant insertion are retrospectively analyzed in correlation with the patient's clinical course. RESULTS: The retrospective imaging review shows a left lower abdominal seed anterior to the left psoas muscle. CT re-evaluation localizes the seed in the left testicular vein. This embolized seed was not initially identified on any imaging modality. Although there is no solid cause-effect proof in this case, the fully potent embolized seed may be contributory to the patient's testicular symptomatology. CONCLUSION: The uncommon seed relocation to the left testicular vein is probably because of periprostatic-pampiniform venous communication.