Reacciones sarcoideas relacionadas con inhibidores de puntos de control inmunitario / Sarcoid-like Reactions to Immune Checkpoint Inhibitors

Los inhibidores de puntos de control inmunitario (ICI) pueden producir toxicidades cutáneas inmunomediadas entre las que se encuentran las reacciones sarcoideas. Nuestro objetivo fue analizar retrospectivamente los datos clínicos e histológicos de los pacientes en tratamiento con ICI que desarrollaron reacciones sarcoideas cutáneas entre 2019 y 2022. Se incluyeron siete pacientes (seis mujeres y un varón, con una edad mediana de 65años). La mediana de tiempo de instauración de la clínica fue de 4meses y la forma de presentación más frecuente fue la sarcoidosis papulosa de las rodillas, seguida de la sarcoidosis subcutánea. En todos se confirmó el diagnóstico histológicamente y no se observaron diferencias respecto a la sarcoidosis idiopática. Solo en dos casos fue preciso retirar la inmunoterapia. Las reacciones sarcoideas por ICI suelen ser leves y no suelen requerir la interrupción del tratamiento. Es fundamental obtener una confirmación histológica para distinguirlas de la progresión tumoral (AU)

Immune checkpoint inhibitors (ICIs) can cause immune-mediated cutaneous adverse events, including sarcoid-like reactions. The aim of this study was to retrospectively analyze clinical and histologic data from patients who developed cutaneous sarcoid-like reactions between 2019 and 2022 while under treatment with ICIs. We studied 7 patients (6 women and 1 man) with a median age of 65years. Median time to onset of symptoms was 4months. The most common presentation was papular sarcoidosis of the knees followed by subcutaneous sarcoidosis. Diagnosis was confirmed histologically in all cases, and no differences were observed relative to idiopathic sarcoidosis. Discontinuation of ICI therapy was required in just two patients. ICI-induced sarcoid-like reactions tend to be mild and generally do not require treatment discontinuation. Histologic confirmation is essential for distinguishing these reactions from tumor progression (AU)

[Translated article] Sarcoid-like Reactions to Immune Checkpoint Inhibitors / Reacciones sarcoideas relacionadas con inhibidores de puntos de control inmunitario

Immune checkpoint inhibitors (ICIs) can cause immune-mediated cutaneous adverse events, including sarcoid-like reactions. The aim of this study was to retrospectively analyze clinical and histologic data from patients who developed cutaneous sarcoid-like reactions between 2019 and 2022 while under treatment with ICIs. We studied 7 patients (6 women and 1 man) with a median age of 65years. Median time to onset of symptoms was 4months. The most common presentation was papular sarcoidosis of the knees followed by subcutaneous sarcoidosis. Diagnosis was confirmed histologically in all cases, and no differences were observed relative to idiopathic sarcoidosis. Discontinuation of ICI therapy was required in just two patients. ICI-induced sarcoid-like reactions tend to be mild and generally do not require treatment discontinuation. Histologic confirmation is essential for distinguishing these reactions from tumor progression (AU)

Los inhibidores de puntos de control inmunitario (ICI) pueden producir toxicidades cutáneas inmunomediadas entre las que se encuentran las reacciones sarcoideas. Nuestro objetivo fue analizar retrospectivamente los datos clínicos e histológicos de los pacientes en tratamiento con ICI que desarrollaron reacciones sarcoideas cutáneas entre 2019 y 2022. Se incluyeron siete pacientes (seis mujeres y un varón, con una edad mediana de 65años). La mediana de tiempo de instauración de la clínica fue de 4meses y la forma de presentación más frecuente fue la sarcoidosis papulosa de las rodillas, seguida de la sarcoidosis subcutánea. En todos se confirmó el diagnóstico histológicamente y no se observaron diferencias respecto a la sarcoidosis idiopática. Solo en dos casos fue preciso retirar la inmunoterapia. Las reacciones sarcoideas por ICI suelen ser leves y no suelen requerir la interrupción del tratamiento. Es fundamental obtener una confirmación histológica para distinguirlas de la progresión tumoral (AU)

Sarcoid-like Reactions to Immune Checkpoint Inhibitors. / Reacciones sarcoideas relacionadas con inhibidores de puntos de control inmunitario.

Immune checkpoint inhibitors (ICIs) can cause immune-mediated cutaneous adverse events, including sarcoid-like reactions. The aim of this study was to retrospectively analyze clinical and histologic data from patients who developed cutaneous sarcoid-like reactions between 2019 and 2022 while under treatment with ICIs. We studied 7 patients (6 women and 1 man) with a median age of 65years. Median time to onset of symptoms was 4months. The most common presentation was papular sarcoidosis of the knees followed by subcutaneous sarcoidosis. Diagnosis was confirmed histologically in all cases, and no differences were observed relative to idiopathic sarcoidosis. Discontinuation of ICI therapy was required in just two patients. ICI-induced sarcoid-like reactions tend to be mild and generally do not require treatment discontinuation. Histologic confirmation is essential for distinguishing these reactions from tumor progression.

[Translated article] Sarcoid-like Reactions to Immune Checkpoint Inhibitors.

Immune checkpoint inhibitors (ICIs) can cause immune-mediated cutaneous adverse events, including sarcoid-like reactions. The aim of this study was to retrospectively analyze clinical and histologic data from patients who developed cutaneous sarcoid-like reactions between 2019 and 2022 while under treatment with ICIs. We studied 7 patients (6 women and 1 man) with a median age of 65years. Median time to onset of symptoms was 4months. The most common presentation was papular sarcoidosis of the knees followed by subcutaneous sarcoidosis. Diagnosis was confirmed histologically in all cases, and no differences were observed relative to idiopathic sarcoidosis. Discontinuation of ICI therapy was required in just two patients. ICI-induced sarcoid-like reactions tend to be mild and generally do not require treatment discontinuation. Histologic confirmation is essential for distinguishing these reactions from tumor progression.

Linfoma cutáneo primario T CD8+ tipo acral inducido por hipersensibilidad retardada persistente a pendientes de oro / Primary Cutaneous Acral CD8+ T-cell Lymphoma Induced by Persistent Delayed Hypersensitivity to Gold Earrings

El linfoma cutáneo primario T CD8+ tipo acral ha sido incluido como entidad provisional dentro de la nueva clasificación revisada de las neoplasias linfoides de la Organización Mundial de la Salud en 20161. Inicialmente fue descrito como proliferación linfoide CD8+ indolente de la oreja2, y se han publicado en la literatura un total de 29 casos de dicha neoplasia. Ninguno de ellos se ha relacionado con reacciones de hipersensibilidad retardada de contacto. Presentamos un caso de linfoma cutáneo primario T CD8+ tipo acral auricular bilobular en clara relación etiológica con el uso prolongado de unos pendientes de oro confirmada con pruebas epicutáneas, estudio histológico, inmunohistoquímico y molecular. Las lesiones cutáneas bilobulares fueron inducidas de nuevo con un test de uso e idénticos resultados a los iniciales y misma clonalidad, lo cual terminó de confirmar tanto el diagnóstico del linfoma como su inducción por el estímulo antigénico del oro (AU)

Primary cutaneous CD8+ T-cell lymphoma has been included as a provisional entity within the new revised classification of lymphoid neoplasms of the World Health Organization in 20161. It was initially described as indolent CD8+ lymphoid proliferation of the ear2 and a total of 29 cases of such neoplasm have been published in the literature so far. None of them have been linked to delayed contact hypersensitivity reactions. We present a case of acral type primary cutaneous lymphoma T CD8+ involving both earlobes clearly related with the prolonged use of gold earrings, confirmed with epicutaneous tests, histopathology, immunohistochemical and molecular studies. Auricular skin lesions were induced again with a provocation test with identical histopathologycal and the same clonality, confirming both the diagnosis of lymphoma and its induction by the antigenic stimulus of gold (AU)

Primary Cutaneous Acral CD8+ T-cell Lymphoma Induced by Persistent Delayed Hypersensitivity to Gold Earrings. / Linfoma cutáneo primario T CD8+ tipo acral inducido por hipersensibilidad retardada persistente a pendientes de oro.

Primary cutaneous CD8+ T-cell lymphoma has been included as a provisional entity within the new revised classification of lymphoid neoplasms of the World Health Organization in 20161. It was initially described as indolent CD8+ lymphoid proliferation of the ear2 and a total of 29 cases of such neoplasm have been published in the literature so far. None of them have been linked to delayed contact hypersensitivity reactions. We present a case of acral type primary cutaneous lymphoma T CD8+ involving both earlobes clearly related with the prolonged use of gold earrings, confirmed with epicutaneous tests, histopathology, immunohistochemical and molecular studies. Auricular skin lesions were induced again with a provocation test with identical histopathologycal and the same clonality, confirming both the diagnosis of lymphoma and its induction by the antigenic stimulus of gold.

Análisis del valor de la biopsia del gangliocentinela en el melanoma cutáneo / Analysis in the meaning of sentinel lymph node biopsy in cutaneous melanoma

El melanoma cutáneo es una neoplasia cuya incidencia va en aumento en nuestro medio. Presentamos un estudio sobre 1023 casos de esta patología recogidos a lo largo de 20 años, distribuidos en 2 grupos: grupo A tratados antes del 2000, y grupo B tratados después del2000. Comparamos la supervivencia de ambos grupos en base al cambio de tratamiento por la introducción del estudio del ganglio centinela a partir del año 2000.No observamos diferencias significativas entre los 2grupos en la supervivencia de los pacientes con melanoma a pesar de realizar tratamientos más conservadores. Por tanto, gracias a la biopsia de ganglio centinela, se pueden evitar un 75% de linfadenectomías electivas realizadas en este tipo de patología sin modificar los índices de supervivencia (AU)

The incidence of cutaneous melanoma has increased in our country recently. We report our experience during 20 years in 1023cases, comparing the survival between 2 groups of patients: group A treated before 2000, and group B treated after 2000, based on the different treatment after the introduction of sentinel lymph node biopsy in 2000.There are no differences in survival rates between both groups in spite of being more conservative. Moreover,75% of the lymphadenectomy could be evitated (AU)