Angiotropism in Primary Cutaneous Melanoma With Brain Metastasis: A Study of 20 Cases
Angiotropism in Primary Cutaneous Melanoma With Brain Metastasis: A Study of 20 Cases
复制标题
DOI：
10.1097/dad.0b013e31827e8315ad
复制
发表时间：
2013-08-01
影响因子：
1.1
通讯作者：
Barnhill, Raymond L.
中科院分区：
文献类型：
--
作者：
Hung, Tawny;Morin, Jason;Barnhill, Raymond L.
以往的临床和实验研究表明，脑转移性黑色素瘤的侵袭可能遵循血管通道的外表面，即血管外迁移转移。这种向血管的侵袭与神经系统的肿瘤性胶质细胞侵袭相似。因此，我们回顾性研究了20例原发性黑色素瘤病例及其相应的脑转移灶。在每个原发性黑色素瘤中分析以下参数：血管向性的存在、Breslow厚度、Clark水平、有丝分裂率、前哨淋巴结（SLN）状态和原发性病变与转移之间的时间间隔。检查转移性脑病变是否存在血管生成。20例中，14例原发灶呈血管向性。促血管生成组的Breslow厚度明显更深（中位数4.4 mm vs. 1.4 mm，P <0.01），核分裂更活跃（中位数11 vs. 4.7个核分裂/mm（2），P = 0.04）。有趣的是，促血管生成组从原发病灶到脑转移的平均时间间隔为33个月，而非促血管生成组的时间间隔为57个月。尽管Kaplan-Meier分析未能显示该小队列中的生存差异（P = 0.235），但存在显著性趋势。20例脑转移瘤中有7例表现出血管向性;然而，原发性黑色素瘤的血管向性与相应的转移性病变之间无显著相关性。事实上，脑转移瘤的血管生成性很难评估，因为可用的材料通常是小的部分活检样本，许多显示明显的坏死。10例黑色素瘤患者接受SLN活检。6例阳性病例中，3例为促血管组，从原发灶到脑转移的平均时间为32个月，而4例为非促血管组，从原发灶到脑转移的平均时间为63个月。原发性黑色素瘤及其相应脑转移瘤的血管生成性的初步研究显示了一个惊人的趋势，表明原发性黑色素瘤的血管生成性可能预示脑转移瘤的快速发展。这项研究也表明，由于样本量小和坏死组织丰富，研究黑色素瘤脑转移瘤的血管生成性是困难的。作者正在收集更大和更有代表性的黑色素瘤脑转移瘤的数量，以供进一步研究。
Previous clinical and experimental studies suggested that invasion of the brain by metastatic melanoma may follow the external surfaces of vascular channels, that is, angiotropic extravascular migratory metastasis. Such angiotropic invasion seemss analogous to that of neoplastic glial invasion of the nervous system. We, therefore, have retrospectively investigated 20 primary melanoma cases and their respective metastatic brain lesions. The following parameters were analyzed in each primary melanoma: presence of angiotropism, Breslow thickness, Clark level, mitotic rate, sentinel lymph node (SLN) status, and time interval between the primary lesion and the metastasis. The metastatic brain lesions were examined for the presence of angiotropism. Of the 20 cases, 14 showed angiotropism in the primary lesion. The angiotropic group had a significantly deeper Breslow thickness (median 4.4 mm vs. 1.4 mm, P < 0.01) and was more mitotically active (median 11 vs. 4.7 mitoses/mm(2), P = 0.04). Interestingly, the angiotropic group had an average time lapse of 33 months from the primary lesion to the brain metastasis, whereas the nonangiotropic group had a 57-month time interval. Although the Kaplan-Meier analysis failed to show a survival difference in this small cohort (P = 0.235), there was a trend toward significance. Seven of 20 brain metastases showed angiotropism; however, no significant correlation between angiotropism in the primary melanomas and the corresponding metastatic lesions could be demonstrated. Indeed, angiotropism in the brain metastases was difficult to assess because the available material were generally small partial biopsy samplings and many showed conspicuous necrosis. Ten melanoma patients underwent SLN biopsy. The 3 of 6 positive cases in the angiotropic group had an average time lapse of 32 months from the primary lesion to the brain metastasis, whereas the 4 positive SLN biopsies in the nonangiotropic group had an average of 63 months. This preliminary study of angiotropism in primary melanomas and their corresponding brain metastasis shows a striking trend suggesting that angiotropism in primary melanomas may predict the rapid development of brain metastases. This study also has demonstrated the difficulty in studying angiotropism in melanoma brain metastases because of small sample sizes and abundance of necrotic tissue. The authors are in the process of collecting larger and more representative numbers of melanoma brain metastases for further investigations.