Neoadjuvant chemotherapy: a new criterion for selection of candidate patients for surgery of low tumour burden metastases from malignant melanoma?

BACKGROUND: Surgery of limited metastatic lesions from malignant melanoma can achieve long-term remission and better survival than chemotherapy. Existing criteria for selection of candidate patients for this surgery do not seem sufficient to avoid useless excisions. OBJECTIVES: To test use of neoadjuvant chemotherapy as a new criterion in this setting. METHODS: All patients who underwent thoracic surgery for one or two lung metastases from melanoma during 1999-2007 were included in the study. Demographic and medical data were collected and analysed. Several possible prognostic factors were evaluated based on the overall survival curves. RESULTS: Thirteen patients were included in this retrospective study. All but two patients had no evidence of disease after surgery. Ten patients received neoadjuvant chemotherapy. Six responded (absence of progression) and four had progressive disease. Response to chemotherapy and no evidence of disease after surgery were predictive of long-term survival. CONCLUSIONS: Neoadjuvant chemotherapy can be considered as a new criterion for better selection of candidate patients for lung metastasis surgical resection. This would also avoid useless surgical procedures in rapidly progressive disease and give information on the chemosensibility of the metastatic disease. This study needs further confirmation, particularly with chemotherapy regimens that have demonstrated better objective responses.

[Two cases of pulmonary melanoma metastasis treated with radiofrequency: An alternative to surgical excision]. / Deux cas de métastases pulmonaires de mélanome traitées par radiofréquence : une alternative à la chirurgie.

BACKGROUND: based on consensual recommendations, surgery remains the standard treatment for curable lung metastases. In this setting, radiofrequency ablation of limited metastases has been described in numerous studies in recent years. We report herein two patients presenting with low-burden lung metastases from malignant melanoma treated by radiofrequency. PATIENTS AND METHODS: two patients presented with one to two limited burden lung metastases from malignant melanoma, respectively. Both patients received neoadjuvant chemotherapy leading to disease stabilization, after which the lung metastases were treated by radiofrequency. Both patients had complete remission following radiofrequency, with 12 and 21 months follow-up respectively. DISCUSSION: surgical treatment of solitary or scant pulmonary metastases from melanoma has proved its efficacy with a gain in overall and disease-free survival. Nevertheless, this treatment cannot be proposed in patients with contraindications for anaesthesia or compromised pulmonary function. In this population, radiofrequency ablation appears to offer a potentially valuable alternative to surgery. Additionally, the related morbidity and duration of hospitalisation associated with radiofrequency seemed to be improved. As seen in these two cases, the efficacy and increased survival achieved with radiofrequency appears comparable to those obtained through surgery.

[Cutaneous CD8+ squamous T-cell bullous lymphoma]. / Lymphome cutané épidermotrope CD8 + bulleux.

INTRODUCTION: Bullous forms of cutaneous T-cell lymphomas are rare. A new group of cutaneous T-cell lymphomas has recently been identified as a distinct clinicopathological and immunophenotype entity. These cutaneous T-cell lymphomas express a CD8+ phenotype, rarely expressed in other cutaneous T-cell lymphomas. CASE REPORT: We describe a cutaneous CD8+ squamous T-cell lymphoma with polymorphic clinical features, strongly epidermotropic lymphoid infiltrate and spongiosis, classical for this type of lymphoma. DISCUSSION: Bullous lesions in cutaneous T-cell lymphoma should evoke the possibility of a cutaneous CD8+ T-cell lymphoma, once other bullous diseases have been excluded. Spongiosis, rare in other types of T-cell lymphoma, and strongly epidermotropic pleomorphic lymphoid infiltrate are classical histological features. The association of polymorphic lesions, bullas and atypical CD8+ epidermotropic phenotype should evoke this diagnosis even at the early stage. Treatment is difficult and classical chemotherapy often fails. Prognosis is poor with a mean overall survival of 32 months.

[Candidiasis involvement of the small intestine complicated by perforation. A case of favorable course]. / Atteinte candidosique de l'intestin grêle compliquée de perforation. Un cas d'évolution favorable.

We report the case of a 51 year-old man who developed candidiasis of the small bowel associated with intestinal perforation. This condition is very rarely recognized ante mortem. Here, the diagnosis was established by pathological examination of a surgically resected specimen of small bowel at the time of surgery. A complete work-up failed to disclose any predisposing condition to digestive candidiasis. Antifungal therapy resulted in complete recovery.

[Prognosis of acute viral hepatitis in patients with alcoholic cirrhosis]. / Pronostic des hépatites virales aiguës survenant chez des malades atteints de cirrhose alcoolique.

We report 20 cases of alcoholic cirrhosis with superimposed episodes of acute viral hepatitis. Four had acute type B hepatitis and 16, presumed non A non B hepatitis. Before hepatitis, 17 patients had stopped drinking and only four had a complicated cirrhosis. Eighteen patients had received a blood transfusion within the 6 months before the occurrence of hepatitis (mean: 52 days). All patients developed jaundice, 7 encephalopathy, and 5 ascites. The ASAT/ALAT ratio was greater than 1 in 18 patients. Two patients died of hepatic failure. Follow-up was known in 17 of the 18 surviving patients: in all patients jaundice disappeared and transaminases returned to values less than 3 times the upper limits of normal. In our experience, the prognosis is good when viral hepatitis occurs in patients with non complicated alcoholic cirrhosis.

[Ecthyma gangrenosum caused by Pseudomonas aeruginosa without septicemia in a neutropenic patient]. / Ecthyma gangréneux à Pseudomonas aeruginosa sans septicémie chez une patiente neutropénique.

INTRODUCTION: Ecthyma gangrenosum is a rare skin infection caused by gram negative bacteria. It involves immunocompromised patients, especially neutropenic patients, and can be easily diagnosed. EXEGESIS: We report a case of ecthyma gangrenosum without septicemia due to Pseudomonas aeruginosa in a myelodysplastic patient with severe neutropenia. Granulocyte growth factors adjunction was necessary in combination to antibiotics to obtain complete healing. CONCLUSION: In neutropenic patient, ecthyma gangrenosum due to Pseudomonas aeruginosa should be rapidly diagnosed to avoid septicemic complications. In the case of antibiotic treatment failure, granulocyte growth factors may be added. Frequent Pseudomonas aeruginosa infections justify bacteriologic survey to look for hospital contamination.

[Subacute cutaneous lupus. Evolutive and therapeutic features of a series of 24 cases]. / Lupus cutanés subaigus. Particularités évolutives et thérapeutiques d'une série de 24 cas.

OBJECTIVE: Subacute cutaneous lupus is a clinical entity defined in 1979 by Sontheimer. Anti-malaria drugs are used as standard treatment for flare-ups, but in case of failure, less well-known alternative therapies may be used. The aim of this work was to determine how patients with subacute cutaneous lupus respond to these other treatments. PATIENTS AND METHODS: Twenty-four cases of subacute cutaneous lupus diagnosed between 1980 and 1998 and followed for 5 years (mean, range 3 months to 16 years) were reviewed retrospectively. Anti-malaria drugs were used as first line treatment in 23 cases and thalidomide alone or in combination in 13 cases. RESULTS: Prognosis of subacute cutaneous lupus was good in our series. There was no renal involvement and none of the patients presented neurological involvement of the psychiatric type. Anti-malaria drugs were insufficient in 13 cases. Thalidomide, either alone or in combination, was then used and was successful in 11 out of 13. Tolerance to treatment was good. Treatment withdrawal was required because of adverse effects in 4 out of 24 patients given anti-malaria drugs and in 3 out of 13 given thalidomide. DISCUSSION: Besides the good prognosis of subacute cutaneous lupus, our series emphasizes the important contribution of thalidomide to second line treatment.

[Sclerosing cholangitis, chronic pancreatitis and Sjögren's syndrome]. / Cholangite sclérosante, pancréatite chronique et syndrome de Sjögren.

A 63 year old man was followed up for chronic pancreatitis. After 2 years, he developed features of primary sclerosing cholangitis associated with Sjögren's syndrome. A review of the literature revealed 38 previous cases of chronic pancreatitis associated with sclerosing cholangitis; a sicca complex was also demonstrated in 3 of these cases. Chronic pancreatitis is mostly asymptomatic and the diagnosis is usually made at laparotomy or postmortem. Retrograde pancreatograms are abnormal in 15-75 p. 100 of patients with primary sclerosing cholangitis. The relationship between the two diseases is not a coincidence. On the other hand, the significance of the association with the Sjögren's syndrome remains controversial.