Tomomichi Ono

Down-Regulation of HLA Class I Antigen-Processing Molecules in Malignant Melanoma: Association with Disease Progression

Expression of the proteasome subunits LMP2 and LMP7, the MHC-encoded transporter subunits TAP1 and TAP2, and HLA Class I antigens was examined by immunoperoxidase staining in 10 nevi and 98 melanoma lesions (60 primary and 38 metastatic), because these molecules play an important role in the presentation of melanoma-associated peptide antigens to cytotoxic T cells. LMP2 was less frequently expressed than LMP7 in primary and metastatic melanoma lesions. TAP1, TAP2, and HLA Class I antigen expression was more frequently (P < 0.05) down-regulated in metastatic than in primary melanoma lesions and in nevi. A synchronous TAP1, TAP2, and HLA Class I antigen down-regulation was observed in 58% of primary and 52% of metastatic lesions. TAP and HLA Class I antigen down-regulation in primary lesions was significantly associated with lesion thickness, stage of disease, reduced time to disease progression, and reduced survival. These results suggest that TAP down-regulation plays a role in the clinical course of malignant melanoma, probably by providing melanoma cells with a mechanism to escape from cytotoxic T lymphocyte recognition during disease progression.

Two cases with cutaneous melanoma who experienced acute myocardial infarction related to chemotherapy

急性心筋梗塞を併発した悪性黒色腫の2例を報告した。症例1, 61歳女性。右上腕原発, pTXN3M1c, stage IVでDAC-Tam療法施行した。3クール目終了6日後に急性心筋梗塞を発症した。タモキシフェン, シスプラチンによる血清中性脂肪の急激な上昇との関連が示唆された。症例2, 69歳男性。右下腿原発, pTXN3M1a, stage IVでDAVFeron療法施行した。2クール第1日目に急性心筋梗塞を発症した。ダカルバジン,酸ビンクリスチン投与3時間後に施行した造影CTで冠動脈血栓が認められ, 学療法による凝固能亢進が血栓形成および心筋梗塞を惹起した可能性がある。化学療法施行にあたっては,筋梗塞のリスクを検討する必要がある。

Malignant Schwannoma without NF-1.

We report two cases of a malignant Schwannoma without NF-1. The first case was a 78-year-old female who presented with an elastic-hard, subcutaneous tumor on her left back area. In 1992, when she was 73 years old, the first resection was performed. In 1996, forty months after the first resection, it recurred locally without distant metastasis when she was 76 years old. After the second surgery, the tumors origin was the accessory nerve based on surgical findings and post-operative clinical symptoms. In 1998, when she was 78 years old, lung metastasis was recognized.The second case was a 59-year-old male who presented with an elastic-hard tumor on his left thigh area. When he was 48 years old, he developed a bruise on his left leg. The tumors origin was the lateral femoral cutaneous nerve based on surgical findings. Long-term follow-up is necessary for patients with malignant schwannoma with or without NF-1. [Skin Cancer (Japan) 2001; 16: 289-294]

Case report of metastatic melanoma to the palatine tonsil.

Metastasis to the oral cavity from cutaneous melanoma is rare. Fewer than 30 cases of metastatic melanoma to the palatine tonsil have been reported in the literature, and only one of them was from Japan. Metastasis to the tonsil, without afferent lymphatics, suggests hematogenous dissemination and a poor prognosis.We present a case of metastatic melanoma restricted to the palatine tonsil. However, in this case, further metastasis has not been recognized in the one and a half years since the tonsillectomy of the metastasic tonsil. We discuss the favorable prognosis from the view point of the antigenic profile of the malenoma cells. [Skin Cancer (Japan) 2000; 15: 57-60]

Reconstruction by vein flap. Reconstruction of skin with malignant tumor by vein flap in consideration of QOL.

The venous flaps were performed in the reconstruction of the excised malignant skin tumors. Case 1, an 85-year-old man presented with a malignant melanoma on the left big toe. The tumor was amputated from the MP joint, and the exposed bone was reconstructed using a 40×50mm venous flap which was elevated on the left dorsal pedis. Case 2, a 77-year-old-woman presented with a squamous cell carcinoma on the left dosal hand. The tumor was excised, and the exposed tendon was reconstructed using a 35×25mm venous flap which was elevated on the left distal forearm. The both cases were successful, and the venous flap is effective for the reconstruction when the bone and tendon are exposed with a small region.

Squamous cell carcinoma postoperative reconstruction. Primary reconstruction case for buccal all layer defect after squamous cell carcinoma excision.

We report a 72-year-old female who demonstrated a suquamous cell carcinoma on the right cheek. On clinical course, this case might be an oral florid papillomatosis with malignant change. It was excised with upper-neck dissection and reconstructed with cervicofacial flap and hinge flap at one-time. There has been no recurrence during 6 months of follow-up and this method was useful for wide cheek defect.

Melanoma associated with satellite lesions.

A 84-year-old Japanese male having a black tumor with satellite lesions on the left back was diagnosed as malignant melanoma (pT4bN1M0 thickness 9.0mm, stage III. The tumor was recurred 4 months after expanded surgical resection and left axillary dissection. He died of malignant melanoma 12 months after operation. Correlation of satellite lesions and prognosis were investigated with regard to 25 patients with stage III malignant melanoma.