Clinic of Medical Oncology, Ozel Ege Sehir Hospital.
Department of Medical Oncology, Tulay Aktas Oncology Hospital.
Melanoma Res. 2022 Aug 1;32(4):286-290. doi: 10.1097/CMR.0000000000000815. Epub 2022 Jun 22.
Immune checkpoint inhibitors (ICIs) represent a new era in stage IV melanoma treatment. These agents are generally well tolerated but have specific side effects. The granulomatous reaction is one of such ICI-related adverse events. In this report, we present the cases of three patients with stage IV melanoma who all developed mediastinal and hilar lymphadenopathy during ICI treatment. While a complete response was observed in one patient, near complete responses were observed in the other two patients. Amid these favorable outcomes, all patients developed mediastinal and hilar lymphadenopathy approximately 6 months after the initiation of immunotherapy. Biopsies were performed to explore the underlying pathology of the lymph nodes, which revealed granulomatous reactions rather than metastases. Hence, immunotherapy was continued in all patients. The development of granulomatous lymphadenitis associated with ICIs may mimic disease recurrence/progression clinically and radiographically. Awareness of such type of adverse event is crucial to decide whether to continue therapy or not.
免疫检查点抑制剂 (ICIs) 代表了 IV 期黑色素瘤治疗的新时代。这些药物通常具有良好的耐受性，但具有特定的副作用。肉芽肿反应是一种与 ICI 相关的不良事件。在本报告中，我们介绍了 3 例 IV 期黑色素瘤患者的病例，他们在 ICI 治疗期间均出现纵隔和肺门淋巴结病。虽然 1 例患者观察到完全缓解，另外 2 例患者观察到接近完全缓解。在这些良好的结果中，所有患者在免疫治疗开始后约 6 个月均出现纵隔和肺门淋巴结病。进行活检以探讨淋巴结的潜在病理学，结果显示为肉芽肿反应而不是转移。因此，所有患者继续接受免疫治疗。与 ICI 相关的肉芽肿性淋巴结炎的发展在临床上和影像学上可能类似于疾病复发/进展。了解此类不良事件至关重要，有助于决定是否继续治疗。
