neděle 5. října 2014

Unexpected post-operative diagnosis of primary rectal melanoma

Anorectal melanoma (ARM) is a very uncommon and highly lethal malignancy. Due to its rarity and non-specific symptoms, preoperative diagnosis may be often erroneous and subsequent treatment inappropriate. We report a case of primary rectal melanoma and discuss the current diagnostic and therapeutic challenges. An 87-year-old man was admitted to our surgical unit with a history of progressive constipation, tenesmus, rectal bleeding and transanal mucous discharge. Preoperative investigations, including CT scan and colonoscopy with biopsy, were suggestive for locally advanced low rectal sarcoma and therefore the patient underwent abdominoperineal resection (APR). However, histopathological examination and immunohistochemistry resulted in a postoperative diagnosis of primary rectal melanoma. The patient died 6 months later due to local and systemic recurrence. ARM should always be considered when unusual anorectal lesions are discovered. Regardless of the pathological stage and the extent of surgery, prognosis of ARM remains poor. Thus, whenever feasible, wide local excision is now the preferred treatment, since it is associated with lower postoperative morbidity and better quality of life compared to APR. In our case, although the initial diagnosis was incorrect, APR was justified by the local invasiveness and large size of the tumor.

as reported in: Erdas E, Calò PG, Licheri S, Pomata M. G Chir. 2014 May-Jun:35(5-6):137-9.

Zdroj:Dgcase


Acute rhabdomyolysis as a complication of interferon treatment for stage IIIc melanoma.



Interferon alfa-2b is a treatment option for select patients with stage 3 melanoma. To highlight the potential complication of acute rhabdomyolysis from interferon alfa-2b in this patient population. We present a case of a 63-year-old female with stage IIIc melanoma who developed acute rhabdomyolysis after completing 2 of 4 weeks of induction with high-dose interferon alfa-2b. She recovered after hydration with intravenous fluids and discontinuation of interferon alfa-2b. Review of the literature revealed eight cases of reported rhabdomyolysis triggered by interferon use, including four cases of melanoma. In patients treated with interferon, especially at high doses, screening for creatine kinase and myoglobinuria should be performed if the patient develops symptoms suggestive of acute rhabdomyolysis.
as reported in: Gavigan G, McEvoy A, Young V. J Cutan Med Surg. 2014 Jul-Aug:18(4):277-9

Zdroj: Dgcases

pondělí 3. prosince 2012

Pacientka s karcinomem sigmoidea s masivním metastatickým postižením jater » Moje Medicina

Pacientka s karcinomem sigmoidea s masivním metastatickým postižením jater » Moje Medicina

ůvodně 44 letá žena byla vyšetřena v našem onkologickém centru v listopadu 2008. Byl u ní zjištěn metastatický karcinom sigmatu s mnohočetným metastatickým postižením jater. Pacientka neměla žádné komorbidity. 12. 11. 20008 byla u pacientky provedena paliativní resekce sigmatu. Nález byl hodnocen jako adenokarcinom sigmatu pT3pN1(1+/9)M1. Mnohočetné metastatické postižení jater, postihující více než 60% parenchymu. Vstupní hodnoty markerů byly CEA 579, CA 19-9 439. RTG plic neprokázal další lokality metastatického postižení.......