Diffuse large B-cell lymphoma mimicking metastatic melanoma: the importance of biopsies in the era of immune checkpoint inhibitors.

IF 1.5 4区 医学 Q3 DERMATOLOGY
Melanoma Research Pub Date : 2025-06-01 Epub Date: 2025-02-27 DOI:10.1097/CMR.0000000000001028
Sarah Janßen, Andrew Moufarrej, Robin Springer, Lena Häberle, Paul Jäger, Christina Antke, Bernhard Homey, Harm-Henning Lindhof
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引用次数: 0

Abstract

Positron emission tomography (PET)/computed tomography (CT) imaging is an established tool in diagnosing and staging for various malignancies, however, during immune checkpoint inhibitor (ICI) therapy not only inflammatory changes may mimic disease progression, but also secondary malignancies should be considered in the setting of unusual clinical and radiographic findings. Here, we present the case of a 64-year-old man with a lymphogenic metastatic malignant melanoma treated with ipilimumab/nivolumab, in whom PET/CT indicated tumor progression of an intra-abdominal mass. Biopsy revealed an unusual reactive T-cell expansion without clonal expansion, pathologically consistent with ICI-induced immune response. As the patient's general condition worsened, we switched to targeted therapy, which had to be discontinued due to increasing fatigue. Follow-up PET/CT at 6 months showed further intra-abdominal progression. Subsequent histopathology of the extirpated mesenteric lymph node conglomerate now revealed diffuse large B-cell lymphoma. Our case highlights the importance of repeated histologic examinations of radiologic pathologies to distinguish secondary malignancies from ICI-induced inflammatory reactions or progressive disease.

模拟转移性黑色素瘤的弥漫性大b细胞淋巴瘤:免疫检查点抑制剂时代活检的重要性
正电子发射断层扫描(PET)/计算机断层扫描(CT)成像是诊断和分期各种恶性肿瘤的既定工具,然而,在免疫检查点抑制剂(ICI)治疗期间,不仅炎症变化可能模仿疾病进展,而且在不寻常的临床和放射学表现的背景下,应考虑继发性恶性肿瘤。在这里,我们报告了一例64岁的男性淋巴源性转移性恶性黑色素瘤患者,接受易普利姆单抗/纳沃单抗治疗,PET/CT显示腹内肿块肿瘤进展。活检显示异常反应性t细胞扩增,无克隆扩增,病理上与ici诱导的免疫反应一致。随着患者整体病情的恶化,我们转而采用靶向治疗,但由于患者的疲劳感加剧,不得不停止这种治疗。随访6个月PET/CT显示腹腔内进一步进展。随后对切除的肠系膜淋巴结丛的组织病理学检查显示弥漫性大b细胞淋巴瘤。我们的病例强调了放射病理学反复组织学检查的重要性,以区分继发性恶性肿瘤与ici诱导的炎症反应或进行性疾病。
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来源期刊
Melanoma Research
Melanoma Research 医学-皮肤病学
CiteScore
3.40
自引率
4.50%
发文量
139
审稿时长
6-12 weeks
期刊介绍: ​​​​​​Melanoma Research is a well established international forum for the dissemination of new findings relating to melanoma. The aim of the Journal is to promote the level of informational exchange between those engaged in the field. Melanoma Research aims to encourage an informed and balanced view of experimental and clinical research and extend and stimulate communication and exchange of knowledge between investigators with differing areas of expertise. This will foster the development of translational research. The reporting of new clinical results and the effect and toxicity of new therapeutic agents and immunotherapy will be given emphasis by rapid publication of Short Communications. ​Thus, Melanoma Research seeks to present a coherent and up-to-date account of all aspects of investigations pertinent to melanoma. Consequently the scope of the Journal is broad, embracing the entire range of studies from fundamental and applied research in such subject areas as genetics, molecular biology, biochemistry, cell biology, photobiology, pathology, immunology, and advances in clinical oncology influencing the prevention, diagnosis and treatment of melanoma.
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