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The surgical treatment of a melanoma patient with macroscopic metastasis in peri and retrocaval lymph nodes and with a positive sentinel lymph node in the groin
No full textINTRODUZIONE: Lâestensione della linfadenectomia in pazienti affetti da melanoma con linfonodo sentinella inguinale metastatico à ̈ molto dibattuta. Gli studi piÃ1 recenti â in accordo con le linee guida per il trattamento chirurgico di carcinomi del tratto uro-genitale â suggeriscono lâestensione della dissezione chirurgica ai linfonodi iliaco-otturatori. Attualmente, perÃ2, i limiti anatomici e lâindicazione allâallargamento pelvico della linfadenectomia inguinale non sono ancora definiti.CASE REPORT: Un uomo di 46 anni con un melanoma nodulare cutaneo sulla faccia antero-mediale della gamba destra à ̈ stato sottoposto a biopsia del linfonodo sentinella dellâinguine, risultato positiva per macrometastasi. Dopo 2 settimane à ̈ stata eseguita la linfadenectomia inguinale con completamento con dissezione pelvica estesa; ma durante lâintervento à ̈ stata notata la presenza di metastasi macroscopicamente visibili anche in sede peri e retro cavale. Si à ̈ optato pertanto per passare alla linfadenectomia pelvica super-estesa, rimuovendo anche questi linfonodi. In totale sono stati rimossi 56 linfonodi, 54 sono risultati macrometastatici e di questi ultimi 9 erano peri-cavali e 2 retro-cavali. Dopo 49 mesi il paziente à ̈ giunto alla nostra attenzione per metastasi scrotali multiple, in assenza di ulteriori localizzazioni secondarie.DISCUSSIONE: Attualmente non ci sono linee guida per i pazienti affetti da melanoma a riguardo di indicazioni e limiti anatomici dellâestensione iliaco-otturatoria. La dissezione pelvica estesa à ̈ la procedura chirurgica di elezione nei pazienti affetti da carcinoma uro-genitali. In caso di riscontro intraoperatorio di macrometastasi in regione peri/retro cavale, lâapproccio da seguire risulta ancora piÃ1 incerto. Noi abbiamo eseguito una dissezione super-estesa pelvica con una buona prognosi per il paziente.CONCLUSIONI: Questo case-report testimonia la necessità di analizzare accuratamente lâeventuale presenza di metastasi linfatiche macroscopicamente visibili in regione peri/retro cavale, mettendo in evidenza la necessità di ulteriori studi per valutare la frequenza di metastasi in tale localizzazione nonché di sviluppare linee guida specifiche su indicazione ed estensione della dissezione pelvica nei pazienti affetti da melanoma con metastasi linfonodali inguinali.BACKGROUND: The extension of iliac-obturator dissection in melanoma patient with metastatic sentinel node of the groin is very debated. More recent studies - in accord with guidelines for urogenital cancers - suggest the extension to pelvic lymph nodes. At present, however, anatomical limits and indications to pelvic dissection are not defined in melanoma patients with metastatic lymph nodes of groin.CASE REPORT: A 46-year-old man affected by nodular cutaneous melanoma (Breslow-thickness 10 mm, Clark-level V) on the anterior-medial surface of the right leg underwent sentinel node biopsy of groin. Three macro-metastatic sentinel lymph nodes were removed in right inguinal field and, after 2 weeks, an ipsi-lateral inguinal lymphadenectomy with an extended pelvic dissection was performed. During the surgery, we reported the presence of macrometastases also in retro/peri caval lymph nodes. As a result of these findings, we decided to perform the super-extended pelvic lymphadenectomy. Overall we removed 56 lymph nodes with 9 peri-caval and 2 retro-caval macro metastatic lymph nodes. After a period of 49 months, the patients came to our attention with multiple scrotal metastases. The imagining restaging of the patient was already negative for other melanoma localizations.DISCUSSION: Currently there are no guidelines about indications and anatomical limits of iliac-obturator extension in melanoma patients. The extended pelvic dissection is the gold-standard procedure used in urogenital carcinomas. In case of finding of macro-metastases during the surgical procedure, the approach to follow is even more uncertain. We perform a super-extended pelvic dissection with a good prognosis for the patient.KEY WORDS: Caval-metastasis, Extended-pelvic-lymphadenectomy, Metastatic-melanoma
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Interval sentinel lymph nodes in melanoma: a digital pathology analysis of Ki67 expression and microvascular density
No full textThe presence of interval sentinel lymph nodes
in melanoma is documented in several studies, but controversies
still exist about the management of these lymph
nodes. In this study, an immunohistochemical evaluation
of tumor cell proliferation and neo-angiogenesis has been
performed with the aim of establishing a correlation
between these two parameters between positive and
negative interval sentinel lymph nodes. This retrospective
study reviewed data of 23 patients diagnosed with melanoma.
Bioptic specimens of interval sentinel lymph node
were retrieved, and immunohistochemical reactions on
tissue sections were performed using Ki67 as a marker of
proliferation and CD31 as a blood vessel marker for the
study of angiogenesis. The entire stained tissue sections
for each case were digitized using Aperio Scanscope Cs
whole-slide scanning platform and stored as high-resolution
images. Image analysis was carried out on three
selected fields of equal area using IHC Nuclear and Microvessel analysis algorithms to determine positive
Ki67 nuclei and vessel number. Patients were divided into
positive and negative interval sentinel lymph node groups,
and the positive interval sentinel lymph node group was
further divided into interval positive with micrometastasis
and interval positive with macrometastasis subgroups.
The analysis revealed a significant difference between
positive and negative interval sentinel lymph nodes in the
percentage of Ki67-positive nuclei and mean vessel
number suggestive of an increased cellular proliferation
and angiogenesis in positive interval sentinel lymph
nodes. Further analysis in the interval positive lymph
node group showed a significant difference between
micro- and macrometastasis subgroups in the percentage
of Ki67-positive nuclei and mean vessel number. Percentage
of Ki67-positive nuclei was increased in the
macrometastasis subgroup, while mean vessel number
was increased in the micrometastasis subgroup. The
results of this study suggest that the correlation between
tumor cell proliferation and neo-angiogenesis in interval
sentinel lymph nodes in melanoma could be used as a
good predictive marker to distinguish interval positive
sentinel lymph nodes with micrometastasis from interval
positive lymph nodes with macrometastasis subgroups
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Variations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
Appropriate Similarity Measures for Author Cocitation Analysis
Full text linkWe provide a number of new insights into the methodological discussion about author cocitation analysis. We first argue that the use of the Pearson correlation for measuring the similarity between authors’ cocitation profiles is not very satisfactory. We then discuss what kind of similarity measures may be used as an alternative to the Pearson correlation. We consider three similarity measures in particular. One is the well-known cosine. The other two similarity measures have not been used before in the bibliometric literature. Finally, we show by means of an example that our findings have a high practical relevance.information science;Pearson correlation;cosine;similarity measure;author cocitation analysis
Dispelling the Myths Behind First-author Citation Counts
Full text linkWe conducted a full-scale evaluative citation analysis study of scholars in the XML research field to explore just how different from each other author rankings resulting from different citation counting methods actually are, and to demonstrate the capability of emerging data and tools on the Web in supporting more realistic citation counting methods. Our results contest some common arguments for the continued
use of first-author citation counts in the evaluation of scholars, such as high correlations between author rankings by first-author citation counts and other citation
counting methods, and high costs of using more realistic citation counting methods that are not well-supported by the ISI databases. It is argued that increasingly available digital full text research papers make it possible for citation analysis studies to go beyond what the ISI databases have directly supported and to employ more
sophisticated methods
Single-stage excision and sentinel lymph node biopsy in cutaneous melanoma in selected patients: A retrospective case-control study
No full textSometimes, diagnostic excision of a primary melanoma would already necessitate skin grafting or transposition skin flaps, especially in areas with an esthetic or functional importance. The utility of sentinel lymph node biopsy (SLNB) after skin reconstruction is controversial. We carried out a single-institution retrospective case-control study. In patients with a wide primary lesion at high clinical-dermatoscopic suspicion for invasive melanoma in anatomical region in which a reconstruction with a skin graft or a flap is required, we proposed the performance of a confocal microscopy examination and an incisional biopsy of the primary lesion. If these diagnostic methodologies confirmed the suspicion of melanoma, lymphatic mapping was performed before the wide excision (WE) of the primary lesion, and WE and SLNB were performed during the same operative procedure. The database evaluation showed 496 patients who had undergone a previous complete local excision and a subsequent SLNB (two-stage group), whereas 61 patients underwent WE and SLNB during the same surgical time (one-stage group). Histological results of the excisional biopsy confirmed the diagnosis of melanoma in all patients of the one-stage group. The false-negative rate was lower in the one-stage group (5.5%) than in the two-stage group (16.7%). Patients of the two groups showed a similar recurrence-free and overall survival period even when corrected for clinic-demographical variables. The concomitant execution of SLNB and WE after confocal microscopy examination and incisional biopsy appears to be a safe and accurate procedure in patients with a wide primary melanoma that requires a skin flaps or a skin graft to cover the residual defect
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