Woodbeck Randi, Metelitsa Andrei I, Naert Karen A
Department of Pathology and Laboratory Medicine, University of Calgary and Calgary Laboratory Services, Calgary, Alberta, Canada.
Institute for Skin Advancement, Calgary, Alberta, Canada.
Am J Dermatopathol. 2018 Jul;40(7):523-526. doi: 10.1097/DAD.0000000000001066.
Immune checkpoint inhibitor therapy has revolutionized the treatment of advanced melanoma, with these agents significantly improving survival for patients with metastatic disease. With the increasing use of these agents, the number of adverse reactions secondary to their use has also increased. Sarcoidosis and sarcoid-like reactions are one such immune checkpoint inhibitor-related adverse event. We report a case of sarcoid-like granulomatous tumoral melanosis in a patient on the programmed cell death-1 (PD-1) receptor inhibitor pembrolizumab for metastatic melanoma. This is, to our knowledge, the first reported case of a sarcoidal form of tumoral melanosis in a patient on anti-PD-1 therapy. We postulate that this reflects tumor regression in response to pembrolizumab-induced immune activation, with concomitant therapy-triggered induction of a sarcoid-like reaction. These findings and the literature review presented herein should alert clinicians and pathologists to the possibility of regressed lesions with sarcoid-like features presenting as mimickers of disease progression in patients undergoing immunotherapy for advanced melanoma.
免疫检查点抑制剂疗法彻底改变了晚期黑色素瘤的治疗方式，这些药物显著提高了转移性疾病患者的生存率。随着这些药物使用的增加，其使用继发的不良反应数量也有所增加。结节病和结节样反应就是这样一种与免疫检查点抑制剂相关的不良事件。我们报告了一例在接受程序性细胞死亡-1（PD-1）受体抑制剂派姆单抗治疗转移性黑色素瘤的患者中出现结节样肉芽肿性肿瘤性黑变病的病例。据我们所知，这是首例在接受抗PD-1治疗的患者中报告的结节样肿瘤性黑变病病例。我们推测，这反映了肿瘤对派姆单抗诱导的免疫激活的反应性消退，同时伴随治疗引发的结节样反应的诱导。本文所呈现的这些发现和文献综述应提醒临床医生和病理学家，在接受晚期黑色素瘤免疫治疗的患者中，具有结节样特征的消退性病变有可能表现为疾病进展的模仿者。
