Dermatopathology Update.

Dec 2012

[Article in English, Spanish]

Fernández-Figueras MT, Puig L.

Source

Servicio de Anatomía Patológica, Hospital Universitari Germans Trias i Pujol, Badalona, España; Departamento de Ciencias Morfológicas, Universitat Autònoma de Barcelona, Barcelona, España. Electronic address: maiteffig@gmail.com.

Abstract

This past year has seen a wealth of new developments in dermatopathology that appear to herald the dawning of a new era. Advances in molecular biology and the simplification of techniques have put molecular tests within reach of routine clinical practice and led to a radical change in our approach to lesions such as melanoma; in the future, the genetic characterization of these lesions will be an essential requirement for establishing diagnosis, prognosis, and therapy. 

Technological innovations have also reached dermatology departments: the introduction of ultrasound scans has propitiated the use of fine-needle aspiration cytology, which allows samples to be stained and studied immediately, thereby facilitating diagnosis of superficial and lymph-node lesions, and allowing staging of tumors such as melanoma. Targeted cancer therapies have led to the introduction of more sensitive and specific systems for identifying new targets, have reawakened interest in forgotten diseases such as aggressive basal cell carcinoma, and have led to dermatological reactions that, together with those caused by biologic drugs, we are just beginning to recognize. Consolidated techniques such as immunohistochemistry continue to advance with the addition of new antibodies that contribute considerably to improved diagnosis.

New clinicopathologic diseases have also been described or characterized this year, including 2 new types of melanoma, and progress has been made in our knowledge of other diseases, such as primary cutaneous CD4(+) small/medium-sized pleomorphic T-cell lymphoma. These topics, together with new developments in adnexal tumors, alopecia, and other lesions, will be discussed in this review.

PubMed

PML-IRIS IN A PATIENT TREATED WITH BRENTUXIMAB.

Oct 2012

von Geldern G, Pardo CA, Calabresi PA, Newsome SD.

Source

From the Departments of Neurology (G.v.G., C.A.P., P.A.C., S.D.N.) and Pathology (C.A.P.), The Johns Hopkins Hospital, Baltimore, MD.

Abstract

A 38-year-old woman was diagnosed with cutaneous anaplastic T-cell lymphoma that proved refractory to methotrexate, bexarotene, denileukin diftitox, interferon γ-1b, interferon α-2b, vorinostat, and pralatrexate. She was therefore started on the newly approved monoclonal anti-CD30 antibody brentuximab vedotin. Treatment with brentuximab 1.8 mg/kg IV every 3 weeks quickly led to disappearance of her cutaneous tumors. The day after her second brentuximab infusion she developed word-finding difficulties and unsteady gait. Due to further neurologic deterioration, she was admitted to an outside hospital. Brain MRI revealed multifocal enhancing white matter lesions throughout bilateral cerebral hemispheres and posterior fossa (figure, A-C). Brain biopsy was performed 15 days after her last brentuximab dose to rule out metastases and she was diagnosed with progressive multifocal leukoencephalopathy (PML) (figure, J). The patient was discharged home with hospice care. Upon discharge, she was started on prednisone 50 mg daily to help treat her eczema. Her family brought her to our clinic for a second opinion.

Neurology

Low-Dose Electron Beam Radiation and Romidepsin Therapy for Symptomatic Cutaneous T-CellLymphoma Lesions.

Feb 2012

Akilov OE, Grant C, Frye R, Bates S, Piekarz R, Geskin LJ.

Source

Department of Dermatology, University of Pittsburgh, Pittsburgh, Pennsylvania Medical Oncology Branch, Centre for Cancer Research, National Cancer Institute, Bethesda.

Abstract

Background: 

Romidepsin is a structurally unique histone deacetylase inhibitor FDA-approved for therapy of relapsed or refractory cutaneous T-cell lymphoma (CTCL). Localized electron beam radiation therapy (LEBT) is standard practice in the care of patients with chronically traumatized and painful lesions. Combinational therapy of those two modalities may be beneficial for the therapy of CTCL.

Objectives: 

To report observations on supportive LEBT utilized for isolated refractory lesions in patients on romidepsin.

Methods:  Observations during a phase 2 clinical trial sponsored by the National Cancer Institute (NCI 1312) examining the efficacy of romidepsin for patients with relapsed, refractory, or advanced CTCL, stage IB-IVA mycosis fungoides (MF) or Sézary syndrome. Skin responses were assessed by evaluation of five target lesions only. Patients with objective clinical responses in target lesions who had symptomatic non-target lesions were allowed limited localized radiation to isolated lesions for symptomatic relief. Patients who received localized radiation were not considered complete responders at any point.

Results:  Five patients with advanced MF (3 had stage IIB and 2 had stage IVA2) received localized electron beam radiation to symptomatic non-target lesions while on a protocol with romidepsin. None of these patients experienced additional or unexpected toxicity. Four of the five patients demonstrated fast and durable responses. We noted that significantly lower than standard doses of electron beam radiation effectively treated symptomatic lesions in these patients.

Conclusions:  Electron beam therapy demonstrated significant responses at very low doses without additional toxicity in patients on protocol treatment with the histone deacetylase inhibitor romidepsin. This merits formal investigation in a clinical trial for potential synergy in patients with cutaneous T-cell lymphoma.

British Association of Dermatologists.

Wiley OnLine