PCMC is more frequently found in males and it usually appears between the ages of 50 and Mendoza and Hedwig made the first contemporary description of this eyelid-located tumour.
Taking into consideration the rarity of this tumour, a diagnosis of certitude is difficult to establish until further investigations are made, in order to eliminate the primary malignant tumour with visceral location with mucine production that can metastasize at cutaneous level, as for example that of breast, gastrointestinal tract, lung, kidney, ovary, pancreas, or prostate. The metastatic lesions that originate from the breast or colon are prone hpv dna high risk hc mimic the cutaneous mucinous carcinoma 4.
There is no specific clinical evidence for this type of tumour, as its appearance varies from one patient to another. The first clinical impression is that of a cyst, basal cell carcinoma, keratoacantoma, nevus, apocrine hidrocystoma, another location primary tumour metastasis and in certain circumstances the clinical differentiation includes vascular lesions as those found in the Kaposi sarcoma 5.
Cei mai frecvenți agenți etiologici ai infecțiilor cu transmitere sexuală ITS sunt Neisseria gonorrhoeae, Treponema pallidum, Haemoplilus ducreyi, Chlamydia trachomatis, virusul herpes simplex 2, virusul papilloma uman, Trichomonas vaginalis. Este binecunoscut faptul că cele mai multe ITS sunt simptomatice, dar nu se cunoaște frecvența și importanţa infecţiilor asimptomatice în transmiterea ITS. Dintre infecțile produse de agenți etiologici amintiți, numai în cazul şancrului moale, majoritatea indivizilor sunt simptomatici, cu un număr considerabil de infecţii inaparente.
The patients describe a slow evolution, stretched over several years, of the lesion, completely asymptomatic. Occasional, the very old tumours or the very aggressive ones can invade the adjacent structures 6. Hpv dna high risk hc slow, benign evolution theory of this tumour cheloo needitat correlated with mucine production which is linked to its high celular differentiation grade.
Moreover, the presence of big mucus accumulations can serve as physical barrier in tumour extension, compressing the tumour stroma, slowing the growth, inhibiting the DNA synthesis and decreasing the angiogenesis rate 8.
Although the clinical presentation of PCMC is non-specific, the histopathological exam is pathognomonic. Usually, the tumour is well delimitated, with small accumulations or tubules of epithelial cells which float in mucine.
Mucine is separated by fine collagen fibres septa and is positive to PAS stain, mucicarmina, alcian blue at a pH of 2.
Mucine, same as sialomucine, was characterized as sialidase-labile. The cells are small, basaloid, vacuolated with eosinophilic cytoplasm.
The cellular pleomorfism and the 1. Primary mucinous carcinoma, J Dermatolog Surg Oncol Primary mucinous carcinoma of the skin with metastases to the lymph nodes.
Am J Dermatopathol ; Carcinomas of sweat glands, report of 60 cases. Hpv dna high risk hc Pathol Lab Med ; Smith CC Metastazing carcinoma of the sweat-glands.
Br J Surg43 Primary mucinous carcinoma of the skin: A population based study. Int J Dermatol.
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Further investigations are necessary in order to eliminate the skin metastasis 7,8. The immunohistochemistry exam can facilitate the differential diagnoisis. PCMC cells remain positive for CK 7 and negative for CK 20, the same occurs for the mucinous adenocarcinoma of the breast, but in the case of the mucinous colorectal adenocarcinoma CK 7 is negative and CK 20 is positive.
This way, the absence of CK 20 excludes skin metastases originated from the mucinous colorectal adenocarcinoma. Another CK 7 positive and CK 20 negative tumours, as the adenocarcinoma of the lung or of the gallbladder, can also produce skin metastases. These can be excluded using systemic suplimentary investigations and another types of immunohistochemistry specific colorations 9. Because the skin metastases originating from breast and lung can express the p63 protein, the use of this expression remains controversial and so, further investigations are mandatory.
Quereshi et al.
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In a complex analysis of the skin metastasis, Brownstein et al. The treatment of PCMC imposes local surgical excision. Because of the high local relapse rate, the proper excision with oncological safety margins at least 1 cm is recommended. The patients are informed that the periodical check-ups are of great importance regarding the local recurrence or the appearance of locoregional lymphadenopathy.
Conclusions PCMC is a rare malignant tumour that must be evaluated and treated correctly. The certainty hpv dna high risk hc diagnosis is achieved by histopathological exam, specific investigations for excluding a metastasis, followed by surgical treatment with oncologic safety margins. For the case report presented, we must underline that the local clinical exam was unspecific; the location of the tumour was extremely rare, with local invasion in sternal distal region, the anterior abdominal wall, peritoneum and mediastinum, since the diagnosis needed suplimentary investigations in order to establish the primary cutaneous mucinous adenocarcinoma.
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Mucinous carcinoma of the skin, J Am Acad Dermatol ; Bone marrow relapse in primary mucinous carcinoma of the skin. Am J Clin Oncol ; Report of a case: primary mucinous carcinoma of the skin, Dermatol On J, 14 6 Primary mucinous carcinoma of the eyelid, a clinicopathologic and immunohistochemical study of 4 cases and an update on recurrence rates; Arch Ophthalmol ; 9 Although belived to be uncommon and despite campaigns that hpv dna high risk hc safe sun exposure habbits and early consult for suspicious lesions, the annual incidence is in continuous rise.
Surgery is the best treatment for early stage disease, medical therapy being reserved for adjuvant situations and for unresectable and metastatic melanoma. Chemotherapy offers poor response rates. The introduction of immunotherapy brought a great improvement to melanoma treatment median PFS: This article is a review of the latest clinical trials and therapeutic guidelines regarding immunotherapy in unresectable or metastatic MM.
Keywords: malignant melanoma, therapeutic guidelines, immunotherapy Melanomul malign MM este o tumoră a celulelor care se dezvoltă din melanocite.
REZUMAT URSU RAMONA GABRIELA.pdf
Deşi considerat ca având frecvenţă redusă şi în pofida campaniilor care militează pentru o expunere judicioasă la soare şi consult medical al leziunilor suspecte, incidenţa anuală este în continuă creştere.
Chirurgia este tratamentul cel mai eficient pentru stadiile incipiente, tratamentul medical fiind rezervat în situaţia de adjuvanţă şi în MM inoperabil şi metastatic.
Chimioterapia oferă rate scăzute de răspuns. Introducerea imunoterapiei a adus îmbunătăţiri semnificative în tratamentul melanomului PFS mediu: 11,2 luni pentru tratament combinat şi a oferit unor pacienţi supravieţuire pe termen lung.
Articolul este o recenzie a ultimelor studii clinice şi a ghidurilor terapeutice privind imunoterapia în MM nerezecabil sau metastatic. Cuvinte-cheie: melanom malign, hpv dna high risk hc terapeutice, imunoterapie Introduction Classic agents like dacarbazine DTICchemotherapy combinations like carboplatin and paclitaxel or newer agents like temozolomide yield only modest response rates and have very little influence on overall survival OS.
The turning point hpv dna high risk hc melanoma treatment especially for BRAF mutation negative patients was first reached oxiuri simptome adulti with the introduction of immunotherapy - ipilimumab IPIbut the true improvement was yet to come: ina combination of ipilimumab and nivolumab, which in previously untreated patients boosted a median PFS of over 11 months, something unseen with any other therapy till that moment.
Advantages for immunotherapy are that searching for tumor mutations is less critical and that a number 14 of patients achieve a long term, durable response long term survivors. Ipilimumab Ipilimumab is a CTLA-4 blocker anti-cytotoxic T-lymphocyte associated protein 4 approved for unresectable or metastatic melanoma.
It is a humanized antibody directed at a down-regulatory receptor on activated T-cells 1.
The mechanism of action is by inhibiting T cell inactivation and permitting their specific cytotoxic effect against melanoma cells. Viermi tradus in spaniola have been reported improvements in survival in patients with metastatic melanoma treated with Ipilimumab.
In a phase 3 study by Hodi et al. The median overall survival was 10 months on the arm receiving ipilimumab plus gp, compared with 6. In another phase 3 study, ipilimumab and dacarbazine were compared to dacarbazine and placebo: the survival was improved with 2 months 11 vs. The most common side effects of IPI in this study were rash, diarrhea, fatigue, itching, headache, weight loss and nausea.
P F Е Е S Е S N R Е Т М Р F Н А I R W E О О 1 G М Е Е N N R М А Е N Е Т S Н А S D С N S I 1 А А I Е Е R В R N К S В L Е L О D 1 - Ясно как в полночь в подвале, - простонал Джабба.
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