Malignant melanoma resection and reconstruction with the first manifestation of lumbar metastasis:A case report

BACKGROUND Malignant melanoma(MM)has shown an increasing incidence worldwide,and a potential to metastasize to almost any part of the body.Clinically,MM with bone metastasis as the initial manifestation is extremely rare.Spinal metastatic MM can cause spinal cord or nerve root compression,resulting in severe pain and paralysis.Currently,the primary clinical treatments for MM are surgical resection in conjunction with chemotherapy,radiotherapy,and immunotherapy.CASE SUMMARY Here,we report the case of a 52-year-old male who presented to the clinic with progressive low back pain and limited nerve function.No primary lesion or spinal cord compression was detected from computed tomography and magnetic resonance imaging of the lumbar vertebrae and positron emission tomography scan.A lumbar puncture biopsy confirmed the diagnosis of lumbar spine metastatic MM.Following surgical resection,the patient’s quality of life improved,symptoms were relieved,and comprehensive treatment was initiated,which prevented recurrence.CONCLUSION Spinal metastatic MM is clinically rare,and may cause neurological symptoms,including paraplegia.Currently,the clinical treatment plan consists of surgical resection in combination with chemotherapy,radiotherapy,and immunotherapy.

Evaluation of quality of clinical management of neuroendocrine tumors

Background:Neuroendocrine tumors(NETs)are a group of biologically and clinically heterogeneous neoplasms predominantly found in the gastrointestinal and bronchopulmonary tractus.Despite a rising incidence,implementation of evidence-based standardized care for this heterogenous group remains challenging.The European Neuroendocrine Tumor Society regularly reviews guidelines regarding diagnostic and treatment strategies for NETs.The aim of this study is to shed light on the care of patients with a NET in Belgian Limburg,to provide data as a basis for future studies and to check whether data and results are according to consensus guidelines and outcomes described in literature.Methods:Our study concerned a detailed observational data collection of two large Belgian hospitals(Jessa Hospital Hasselt and Hospital Oost-Limburg Genk)with special interest in patient profile,quality of pathology reports,use of diagnostic imaging,and overall survival.Data on 188 patients were assembled between January 2010 and December 2014 with follow-up until June 2016(median follow-up:33.6 months).Results:Fifty percent of patients were male.NETs were located mainly in the digestive tract(63.8%)and lung(20.2%).Appendiceal NETs were diagnosed at a significantly younger age than other tumors(41.3 vs.64.0 years).Overall,a mean pathology report quality score of 3.0/5 was observed with the highest scores for small bowel NETs.Diagnostic and nuclear imaging was performed in 74.5%and 29.8%of cases,respectively.Seventy-four percent of the population survived until the end of the observation period with highest survival rates for appendiceal and small bowel NETs.Conclusion:Overall,epidemiological results were comparable with findings in the literature.Gastrointestinal NETs met most of the requirements of qualitative pathology reporting and diagnostic imaging as listed in the European Neuroendocrine Tumor Society consensus guidelines.However,consensus with regard to bronchopulmonary NETs is still scarce and remains an objective for future research.Moreover,discussing treatment strategies in specialized multidisciplinary tumor boards would facilitate regional care.