Beyond the Surface: A Case Report of a Patient with Small Bowel Metastasis and Melanoma History. Diagnosis and Management.

Background: Malignant melanoma (MM) is one of the most prevalent and deadliest forms of skin cancer, resulting from the malignant transformation of melanocytes. It accounts for approximately 1.7% of global cancer diagnoses and is the fifth most common cancer in the US. MM can metastasize to almost any part of the body, with early detection significantly improving prognosis. Case presentation: We report the case of an 81-year-old female with a history of malignant melanoma (primary lesion on the left calf) and various comorbidities. She presented with severe anemia of unknown origin. A CT scan was performed due to her medical history, revealing a circumferential, asymmetrical parietal thickening at the level of a hypogastric ileal loop. The lesion suggested a tumoral substrate. Subsequent colonoscopy showed no metastatic lesions, but surgical intervention confirmed a malignant melanoma ileal metastasis. The patient underwent laparoscopic segmental resection with favorable post-surgery outcomes. Histopathological examination of the resected tissue confirmed the diagnosis of small intestine secondary lesions from the malignant melanoma. Conclusion: This case underscores the necessity of considering metastatic melanoma in patients with a history of MM and vague gastrointestinal symptoms. Early and accurate diagnosis through advanced imaging and endoscopic techniques can significantly improve patient outcomes.

A Real-World Study to Compare the Safety and Efficacy of Paritaprevir/Ombitasvir/Ritonavir and Dasabuvir, with or without Ribavirin, in 587 Patients with Chronic Hepatitis C at the Fundeni Clinical Institute, Bucharest, Romania.

BACKGROUND In the European Union, a tablet with fixed doses of ombitasvir, paritaprevir, and ritonavir combined with dasabuvir is an authorized treatment for patients with chronic hepatitis C virus (HCV) infection. Ribavirin is a broad-spectrum antiviral used in several treatment regimens for patients with HCV infection. This real-world study aimed to compare the safety and efficacy of ombitasvir, paritaprevir, and ritonavir combined with dasabuvir, with or without ribavirin, in 587 patients with chronic hepatitis C attending the Fundeni Clinical Institute, Bucharest, Romania. MATERIAL AND METHODS This is an observational prospective study including 315 patients with F4 degree of fibrosis and compensated cirrhosis, 185 patients with F3 fibrosis, and 83 patients with F2 fibrosis. Liver fibrosis was evaluated by liver biopsy or Fibromax. Efficacy was defined as undetectable HCV-RNA at 12 weeks after the end of treatment. In terms of safety, we monitored the development of adverse reactions, liver cytolysis, cholestasis, and hematologic disorders. RESULTS Of the 587 patients, 2 patients with B-cell lymphoma died during therapy. In total, 3/585 patients (0.51%) did not achieve sustained virologic response. Common adverse effects were nausea and asthenia (especially in patients with other medical treatments; P=0.03 and P=0.04, respectively) and anemia in patients who received ribavirin (P<0.01). None of the patients discontinued antiviral treatment. Patients with kidney transplant or end-stage kidney disease did not receive or discontinued ribavirin. CONCLUSIONS Ombitasvir, paritaprevir, and ritonavir combined with dasabuvir, with or without ribavirin had an efficacy rate of over 99% in HCV genotype 1b infection. We report no serious adverse reactions.

Assessing the Spleen as an Organ at Risk in Radiation Therapy and Its Relationship With Radiation-Induced Lymphopenia: A Retrospective Study and Literature Review.

PURPOSE: We conducted a systematic review and a retrospective study to investigate the relationship between spleen irradiation and lymphocyte toxicity. METHODS AND MATERIALS: Forty-six patients diagnosed with locally advanced gastric, esophageal, and pancreatic cancer who underwent radiation therapy were included in this study. The spleen was contoured for each patient. Volumes that received 5 up to 40 Gy (5 Gy increments), minimum, mean, and maximum dose were considered along with lymphocyte count to determine toxicity. Comprehensive and systematic literature searches were performed using PubMed, SCOPUS, Cochrane Central Databases, and Google Scholar. RESULTS: Literature review on spleen unintended irradiation and lymphocyte toxicity resulted in 408 patients from 5 studies. In our study, univariate and multivariate linear regressions found an association between V15 (chemotherapy as controlling factor) and nadir lymphocyte count (P = .04) and between DMAX and nadir lymphocyte count (P = .046). An increase of 1 Gy in mean splenic dose was associated with a 1% decrease in absolute lymphocyte count at nadir. CONCLUSIONS: Although there is no consensus regarding lymphopenia spleen dose volume threshold, all studies found that higher splenic dose increases the risk of lymphopenia. Our study's results suggest that spleen unintentional V15 and maximum dose irradiation were associated with lymphopenia during chemoradiation therapy.