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Ipilimumab-induced skin reactions and nephritis.. Melanoma-associated hypopigmentation (MAH) in a patient exhibiting a partial clinical response (A). Masson's trichome staining showed lymphocytic nephritis in a patient with an ipilimumab-induced drug rash with eosinophilia and systemic symptoms (DRESS) (B). Skin toxicity with the formation of blisters upon induction of treatment with ipilimumab in an area that had been radiated, five weeks earlier, in a patient with previous resection of the distal part of digit II due to an acrolentiginous melanoma (C).
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Five days later the patient developed blisters within the radiated area (Figure 1C).
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Ipilimumab-induced skin reactions and nephritis.. Melanoma-associated hypopigmentation (MAH) in a patient exhibiting a partial clinical response (A). Masson's trichome staining showed lymphocytic nephritis in a patient with an ipilimumab-induced drug rash with eosinophilia and systemic symptoms (DRESS) (B). Skin toxicity with the formation of blisters upon induction of treatment with ipilimumab in an area that had been radiated, five weeks earlier, in a patient with previous resection of the distal part of digit II due to an acrolentiginous melanoma (C).
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Five days later the patient developed blisters within the radiated area (Figure 1C).
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Ipilimumab-induced ischemic gastritis.. Hematoxillin eosin staining showed edematous hypervascularized lamina propria mucosae, foveolar hyperplasia and regenerative basal crypts at 10x magnification (A) and 50x magnification (B). Endoscopic narrow band imaging (NBI) showed signs of reactive chronic inflammation of the gastric corpus mucosa with prominent vascular pattern consistent with an ischemic gastritis (C). Positron emission tomography (PET) scan illustrated high level tracer uptake in the gastric wall consistent with inflammation (D) and its spontaneous resolution after four months with a remaining thickening of the gastric wall (E).
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Biopsy showed an ischemic gastritis compatible with the endoscopic findings (Figure 2).
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Ipilimumab-induced myocardial fibrosis in conjunction with hepatotoxicity.. Hematoxillin eosin staining at 50x magnification (A), 200x magnification (B) and 400x magnification (C) and chloracetate esterase staining at 50x magnification (D), 200x magnification (E) and 400x magnification (F) revealed neutrophilic granulocytes (black arrow) mostly around the central vein (asterisk). Portal fields were almost normal (white arrows). Some necrotic hepatocytes (black arrow heads panel C) and cholestasis of hepatocytes (white arrow heads panel C) indicating liver insufficiency, were detected pericentrally. Slightly elevated myocardial fibrosis (white arrow heads panel F) surrounded by structural changes of cardiomyocytes were detected (black arrow heads panel F).
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Interestingly, one patient showed myocardial fibrosis in conjunction with hepatitis (Figure 3).
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Ipilimumab-induced tumor mass liquefication.. Ulcerated, partially liquefied tumor mass inguinal left (A). Histologic examination confirmed an abundance of necrotic tumor cells with leukocytic infiltration and residual highly pleomorphic tumour cells, haemorrhage and fibrosis (images in hematoxillin eosin staining, magnification 200x; B+C).
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At this time, the tumor bulk on the left-sided abdomen showed two ulcerations with minimal foetid secretion (Figure 4A). This case illustrates ipilimumab's potential to induce strong antitumor immune responses with rapid and sustained tumor destruction (Figure 4B-C).