I apologize in advance for the length of this initial post. I'm sad to be back at this website - the last time I was here was when it was the old-style forum –I see a lot has changed since then.
My husband (now age 65) was diagnosed Stage 2 back in 2008, 1.24mm ulcerated on his right arm. He had a WLE and SLNB, and a couple months later another WLE of the same location since the original had extended to margins. After that though, no further treatment was deemed required and we went about our life. He went to his 6 month appointments for scans and blood work which was eventually pushed out to yearly, with no problems at all. After his last visit in October 2013 with no new issues, we walked out and I felt relieved to have made it past the 5 year mark.
Early in February my husband began being less talkative to me. I had been working in another state since early January (we are moving there soon) and he had also started a new job, so I just attributed it to him being tired from his new job along with the stress of having to live apart for a little while. I asked many times and he insisted nothing was wrong, he just didn't feel like talking. This continued until February 20th when he finally admitted to me that he was having a problem speaking - he couldn’t get his words out - he would just lose his words and couldn't finish his sentences. (He had Expressive Aphasia, we later learned.) It took several more days to convince him to go to the doctor.
On February 24th, he went to his family doctor who immediately sent him to the hospital. He was admitted and I started the 5 hour drive home. Along the way, I received a call from his doctor telling me that he had a brain tumor, 3.1cm with swelling the size of a lemon around it. Two days later, he underwent surgery to remove the tumor, which we were told was in a location that was at least “easy” to get to. The surgery went very quickly and we were told the tumor came out in one whole piece. Scans (CT/MRI) did not find any other tumors in his body.
He was in the hospital for 7 days and rehab for 3 more and is now back home and almost back to “normal”, except for a variety of bad side effects from the Decadron that he still has to take (steroid which reduces the swelling in his brain) and the 8” scar on his newly bald head!
Pathology revealed that it is melanoma. It states the following (hopefully someone can help me interpret this):
A. Received for evaluation, labeled “Brain Tumor FS”, are fragments of pinkish-red tissue, measuring up to 5mm in aggregate dimensions. A portion of this is smeared and the remainder is frozen.
FROZEN SECTION DIAGNOSIS:
A. Brain Tissue, Surgical Biopsy: Cellular Spindle Cell Lesion Await Permanent Section Evaluation.
B. The second specimen, labeled “Brain Tumor/Permanent”, the second specimen on gross evaluation measures up to 40 x 32 x 15 mm in greatest dimensions. One is a more solid larger piece. This is cross sectioned and submitted for review in cassette “B1”. On sectioning, this has a grayish color. Multiple smaller fragments of gray appearing tissue are also received; remainder of the tissue is placed back in formalin solution.
A. Examination of the previously prepared frozen section slides, and then the permanent section material demonstrates the presence of a spindle cell lesion, with limited epithelioid features, and without large numbers of visible mitotic figures. Scattered lymphoid cells are seen, becoming quite pronounced locally within adjacent connective tissue.
B. Examination of multiple sections of the additionally resected material reveals a similar pattern. In places, there is a relatively prominent number of chronic inflammatory cells seen in conjunction with the supporting stroma. In block “B1”, there appears to be dark brown pigment present in conjunction with tumor as well, some of which appears to be actually within neoplastic cells. This lesion has been evaluated by immunoperoxidase studies. It marks strongly for melan-A and HMB-45. Ki-67 reveals profound nuclear marking in portions of the neoplasm.
A. Brain Tissue, Left Frontal, Surgical Biopsy: Hypercellular Spindle and Limited Epithelioid Cell Neoplasm.
B. Brain Tissue, Left Frontal Lobe, Surgical Resection: Metastatic Melanoma.
COMMENT: This patient has a history of cutaneous melanoma removed from one arm several years ago. The entire lesion has a spindle/epithelioid appearance, with the epithelioid area occasionally showing prominent nucleoli. It marks strongly for melan-A and HMB-45, supporting the diagnosis of metastatic malignant melanoma. In part “B”, there are a significant number of mitotic figures identified.
(End of Pathology)
Any help understanding all of that would be appreciated! Is there any information there that that seems positive? Or negative? As hard as it is sometimes to research this topic, learning all I can is the best way I know how to cope, even the bad parts. My husband doesn’t use the internet at all so all he knows at this point is that it is a serious progression of the disease. He leaves the internet scouring/obsessing to me.
This surgery/pathology was done at our local hospital. He has an appointment on Thursday with his regular oncologist (a specialist at a comp. cancer center a little over an hour from where we live) to discuss all of this. I actually have his slides and will deliver them, along with all of the scans, on Monday so they can do their own review ahead of time.
So another question I have is what kind of treatment options (if any) might we expect he be given? I've been reading about the new drugs now available, but I'm not sure these are right for his situation since the entire tumor was removed. A family member who is an expert in (general) oncology said that he would probably need whole brain radiation.
Thank you all again for taking the time to read all of this!
2008: Dx Stage 2 - 1.24mm, ulcerated, right arm. WLE, SNLB.
2014: Dx brain met - 3.1cm resected 2/28/14. TrueBeam 4/14. Start Ipi 6/14.