The relative efficacy of 99mTc sulfur colloid and in vitro-labeled 99mTc red blood cells in detecting and localizing gastrointestinal hemorrhage was evaluated in a prospective tandem study of 100 patients referred for suspicion of gastrointestinal tract hemorrhage. Thirty-eight true-positive scintigrams were obtained with 99mTc red blood cells, whereas 99mTc sulfur colloid detected only five sites of hemorrhage. Scintigraphic findings were corroborated by clinical, endoscopic, arteriographic, and surgical findings. 99mTc red blood cells were clearly superior, with a sensitivity of 93%, specificity of 95%, and overall accuracy of 94% in detecting and localizing gastrointestinal hemorrhage.
A 77-year-old woman developed in-transit and lymphatic metastases from melanoma after multiple previous therapies. She received four doses of ipilimumab 3 mg/kg beginning in September 2011. Fifteen weeks after starting treatment, she developed hypophysitis with low levels of cortisol and thyroid-stimulating hormone; her symptoms responded to appropriate hormonal replacement. Positron emission tomography (PET)/computed tomography scan in May 2012 documented complete remission of her melanoma. She received additional doses of ipilimumab 3 mg/kg in March and June 2012 without apparent adverse effects. A routine PET/computed tomography scan in August 2012 appeared to show a 4.8-cm mass in the uterus (SUV ϭ 9.2) with bilateral iliac lymphadenopathy (Fig 1). She had no pelvic pain, bleeding, or previous gynecological disease. Because of suspicion of recurrent malignancy she had a hysterectomy in September 2012. Pathology showed lymphocytic vasculitis involving uterine and ovarian vessels (Fig 2), with transmural infiltration of lymphocytes and focal fibrin deposition. The iliac lymph nodes that were removed showed only reactive changes. Serologic studies subsequently showed normal antinuclear antibodies but a high titer of antithyroglobulin antibody-3,591 IU/mL (normal, 0-40 IU/mL).
A patient with a bulky inoperable stage IIIC melanoma involving the left axilla and neck from a primary of the left medial elbow received vemurafenib as neo-adjuvant treatment. Based on the molecular analysis, BRAF V600E mutation was present. After 4 months of vemurafinib treatment, the tumours shrank to less than 50% of original clinical size and allowed the surgeons to perform a left modified radical neck dissection and left radical axillary dissection. Pathological analysis of specimen revealed viable metastatic cells only in 1 of 40 nodes resected in the neck and axillary dissection, accounting for over 98% pathological response. Other lymph nodes had a mixture of foamy histiocytic inflammatory reaction fibrosis and islands of necrotic tissues. After recovery from surgery, vemurafenib was resumed and continued for 6 months. He remained disease free 6 months after surgery.
BACKGROUND
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