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Treatment of eyelid lesion of angiosarcoma with facial artery recombinant interleukin-2 (rIL-2) injection
LETTERS CASE
LETTERS
Treatment of eyelid lesion of angiosarcoma with facial artery recombinant interleukin-2 (rIL-2) injection To the Editor: Angiosarcoma of the scalp is an aggressive tumor characterized by a rapid and fatal course. In Japan, this tumor is often treated with intravenous, arterial, or lesional injection of recombinant interleukin-2 (rIL-2).1,2 The external carotid artery (ECA) would normally be selected to administer the drug, but we selected instead the facial artery and implanted a catheter-port system to administer the drug more locally to the lower eyelid lesion. A 92-year-old Japanese male presented with 6month history of angiosarcoma arising from the left frontal scalp. He had been treated since that time with excision, local radiation, and polychemotherapy, including rIL-2, which was administered through a catheter-port system placed at the left ECA. The erythema did not invade down to the same side of the face but gradually spread out to the opposite side of the scalp and face to the right lower eyelid (Fig 1, A) as a result. It caused a serious cosmetic problem and sight difficulties in the right eye. We thought that hypodermal local injection of drugs would be painful and instead inserted a 2.7-5 French tapered catheter from a part of the facial artery running superficially in the mandibular area and placed the port sub cutis in the right supraclavicular fossa under local anesthesia and began injection of rIL-2 (7 3 105 IU/day). We found a reduction of erythema and a lessening of the sight difficulties (Fig 1, B) after 3 weeks. IL-2 is an activator of T cells, including lymphokine-activated killer (LAK) cells, which damage vascular endothelial cells by adhering to the cells and causing lysis. It was demonstrated that angiosarcoma cells are LAK-sensitive, and LAK cells which are induced by rIL-2 suppress tumor growth.1 Therefore, we thought that the more selective administration of smaller doses to the lesion could enhance the anti-tumor effect and reduce the damage to normal endothelial cells. Injection of rIL-2 through the ECA would not cover only the scalp but also the facial region via facial artery. With the catheter-port systems, selective arterial injection of rIL-2 could be managed on the outpatient basis for as long as necessary. The injection of rIL-2 through the facial artery enables more selective administration to the facial J AM ACAD DERMATOL
Fig 1. A, Clinical appearance of the eyelid. Note the invasion of edematous erythema from the scalp. B, After 3 weeks of treatment with rIL-2, most of the erythema has disappeared.
lesion, and we believe that rIL-2 administered with catheter-port system inserted to facial artery could be a good option to treat angiosarcoma in the face. Hiroyuki Miura, MD, PhD Yuji Asada, MD, PhD Department of Dermatology Kansai Rosai Hospital Amagasaki, Japan Conflicts of interest: None identified. Correspondence to: Hiroyuki Miura, MD, PhD Department of Dermatology Kansai Rosai Hospital 1-69, Inabaso 3-chome MAY 2006 907
908 Letters
J AM ACAD DERMATOL MAY 2006
Amagasaki, Hyogo 660-8511, Japan E-mail: [email protected] REFERENCES 1. Masuzawa M, Mochida N, Amano T, Fujimura T, Hamada Y, Tamauchi H, et al. Evaluation of recombinant interleukin-2 immunotherapy for human hemangiosarcoma in a SCID mice model. J Dermatol Sci 2001;27:88-94. 2. Masuzawa M. A remedy strategy for hemangiosarcoma. Jpn J Dermatol 2003;113:1523-33. doi:10.1016/j.jaad.2005.11.1047
Circumscribed palmar hypokeratosis induced by papilloma virus type 4 To the Editor: In 2002, Perez et al1 told of their experience with 10 patients in whom they had diagnosed what they deemed to be a distinctive condition hitherto undescribed and typified by a circumscribed round zone of hypokeratosis lokalized on acral skin. The authors concluded that ‘‘although the nature of circumscribed palmar or plantar hypokeratosis remains uncertain, the presence of the lesions for many years and the absence of any trauma at the site of the lesion support the notion
that this lesion is a localized epidermal malformation.’’ Their article showed photos of clinical features in 4 of their 10 patients and histopathologic findings in 2 of them. In only 2 of their patients did the authors perform polymerase chain reaction (PCR) studies on papilloma virusespecific DNA, with negative results. Clinical and histopathologic findings in those latter 2 patients, however, were not pictured in the article. Subsequent to the publication by Perez et al, various authors reported on patients who presented with similar clinical and histopathologic findings as described by Perez et al, and they all agreed that ‘‘circumscribed palmar and plantar hypokeratosis’’ represented a distinctive condition of unknown etiology.2-7 Some authors expanded on the histomorphologic spectrum of circumscribed palmar and plantar hyperkeratosis, describing a thin layer of parakeratosis, hypergranulosis, and psoriasiform epidermal hyperplasia.6 None of the reports published after the work by Perez et al included any studies by methods of molecular pathology. We want to share with readers our experience with a 60-year-old man who presented with a circumscribed zone of hypokeratosis measuring about 1 cm in diameter on the right palm (Fig 1).
Fig 1. A, A circumscribed, round, slightly erythematous zone of hypokeratosis on the right thenar region. B, Sections stained with hematoxylineeosin show acanthosis covered by hypokeratosis with a thin layer of parakeratosis. Capillaries are elongated and tortuous (original magnification, 320 [top] and 3100 [bottom]). C, PCR demonstrates a fragment of 143 base pairs (lane B; lanes A and C are negative controls), the sequence of which is diagnostic for the L1 gene of human papilloma virus type 4 (GeneBank, BLAST search).
LETTERS
Treatment of eyelid lesion of angiosarcoma with facial artery recombinant interleukin-2 (rIL-2) injection To the Editor: Angiosarcoma of the scalp is an aggressive tumor characterized by a rapid and fatal course. In Japan, this tumor is often treated with intravenous, arterial, or lesional injection of recombinant interleukin-2 (rIL-2).1,2 The external carotid artery (ECA) would normally be selected to administer the drug, but we selected instead the facial artery and implanted a catheter-port system to administer the drug more locally to the lower eyelid lesion. A 92-year-old Japanese male presented with 6month history of angiosarcoma arising from the left frontal scalp. He had been treated since that time with excision, local radiation, and polychemotherapy, including rIL-2, which was administered through a catheter-port system placed at the left ECA. The erythema did not invade down to the same side of the face but gradually spread out to the opposite side of the scalp and face to the right lower eyelid (Fig 1, A) as a result. It caused a serious cosmetic problem and sight difficulties in the right eye. We thought that hypodermal local injection of drugs would be painful and instead inserted a 2.7-5 French tapered catheter from a part of the facial artery running superficially in the mandibular area and placed the port sub cutis in the right supraclavicular fossa under local anesthesia and began injection of rIL-2 (7 3 105 IU/day). We found a reduction of erythema and a lessening of the sight difficulties (Fig 1, B) after 3 weeks. IL-2 is an activator of T cells, including lymphokine-activated killer (LAK) cells, which damage vascular endothelial cells by adhering to the cells and causing lysis. It was demonstrated that angiosarcoma cells are LAK-sensitive, and LAK cells which are induced by rIL-2 suppress tumor growth.1 Therefore, we thought that the more selective administration of smaller doses to the lesion could enhance the anti-tumor effect and reduce the damage to normal endothelial cells. Injection of rIL-2 through the ECA would not cover only the scalp but also the facial region via facial artery. With the catheter-port systems, selective arterial injection of rIL-2 could be managed on the outpatient basis for as long as necessary. The injection of rIL-2 through the facial artery enables more selective administration to the facial J AM ACAD DERMATOL
Fig 1. A, Clinical appearance of the eyelid. Note the invasion of edematous erythema from the scalp. B, After 3 weeks of treatment with rIL-2, most of the erythema has disappeared.
lesion, and we believe that rIL-2 administered with catheter-port system inserted to facial artery could be a good option to treat angiosarcoma in the face. Hiroyuki Miura, MD, PhD Yuji Asada, MD, PhD Department of Dermatology Kansai Rosai Hospital Amagasaki, Japan Conflicts of interest: None identified. Correspondence to: Hiroyuki Miura, MD, PhD Department of Dermatology Kansai Rosai Hospital 1-69, Inabaso 3-chome MAY 2006 907
908 Letters
J AM ACAD DERMATOL MAY 2006
Amagasaki, Hyogo 660-8511, Japan E-mail: [email protected] REFERENCES 1. Masuzawa M, Mochida N, Amano T, Fujimura T, Hamada Y, Tamauchi H, et al. Evaluation of recombinant interleukin-2 immunotherapy for human hemangiosarcoma in a SCID mice model. J Dermatol Sci 2001;27:88-94. 2. Masuzawa M. A remedy strategy for hemangiosarcoma. Jpn J Dermatol 2003;113:1523-33. doi:10.1016/j.jaad.2005.11.1047
Circumscribed palmar hypokeratosis induced by papilloma virus type 4 To the Editor: In 2002, Perez et al1 told of their experience with 10 patients in whom they had diagnosed what they deemed to be a distinctive condition hitherto undescribed and typified by a circumscribed round zone of hypokeratosis lokalized on acral skin. The authors concluded that ‘‘although the nature of circumscribed palmar or plantar hypokeratosis remains uncertain, the presence of the lesions for many years and the absence of any trauma at the site of the lesion support the notion
that this lesion is a localized epidermal malformation.’’ Their article showed photos of clinical features in 4 of their 10 patients and histopathologic findings in 2 of them. In only 2 of their patients did the authors perform polymerase chain reaction (PCR) studies on papilloma virusespecific DNA, with negative results. Clinical and histopathologic findings in those latter 2 patients, however, were not pictured in the article. Subsequent to the publication by Perez et al, various authors reported on patients who presented with similar clinical and histopathologic findings as described by Perez et al, and they all agreed that ‘‘circumscribed palmar and plantar hypokeratosis’’ represented a distinctive condition of unknown etiology.2-7 Some authors expanded on the histomorphologic spectrum of circumscribed palmar and plantar hyperkeratosis, describing a thin layer of parakeratosis, hypergranulosis, and psoriasiform epidermal hyperplasia.6 None of the reports published after the work by Perez et al included any studies by methods of molecular pathology. We want to share with readers our experience with a 60-year-old man who presented with a circumscribed zone of hypokeratosis measuring about 1 cm in diameter on the right palm (Fig 1).
Fig 1. A, A circumscribed, round, slightly erythematous zone of hypokeratosis on the right thenar region. B, Sections stained with hematoxylineeosin show acanthosis covered by hypokeratosis with a thin layer of parakeratosis. Capillaries are elongated and tortuous (original magnification, 320 [top] and 3100 [bottom]). C, PCR demonstrates a fragment of 143 base pairs (lane B; lanes A and C are negative controls), the sequence of which is diagnostic for the L1 gene of human papilloma virus type 4 (GeneBank, BLAST search).