LL-37 is a naturally occurring 37-amino-acid peptide that is part of the innate immune system in human skin. Preclinical studies have showed that intra-tumoral injections of LL-37 stimulate the innate immune system by activation of plasmacytoid dendritic cells, which mediate tumor destruction. LL-37 intra-tumoral injections have been utilized in a phase 1 clinical trial for melanoma patients with cutaneous metastases. We report dermatologic toxicity in a 63-year-old woman with stage IIIC melanoma of the right calf and inguinal lymph nodes. She was previously treated with nivolumab and combination chemotherapy (cisplatin, vinblastine and dacarbazine) and subsequently treated with LL-37 injections upon progression of both prior regimens. She received a total of 8 weekly LL-37 injections, with interval clinical shrinkage of injected lesions. However, approximately 45 days after initiation of this therapy, she presented with multiple verrucous papules and a vesiculo-bullous lesion on the trunk and extremities. Clinically, most of these lesions were thought to be either squamous cell carcinoma or inflamed seborrheic keratosis. Histologically, 11 of the total 12 skin biopsies showed similar histopathologic features, with a prominent lichenoid inflammatory infiltrate admixed with eosinophils and an overlying atypical squamous epithelial proliferation with verrucous and keratoacanthoma-like features and varying degrees of keratinocytic atypia. Interestingly, a majority of the lesions did not show spongiosis (11/12). All lesions resolved within 2 months of cessation of LL-37 injection therapy. This case highlights adverse dermatological manifestations of LL-37 therapy, similar to the consequences of other novel therapies.

Polypoid lesions of the colon can be thought of to be under 3 broad categories: syndromic, mesenchymal, and epithelial.

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Magnetic resonance imaging (MRI) is a supplemental tool to conventional imagining methods for breast evaluation and is primarily used in screening high-risk patients. The high sensitivity for breast abnormalities detection has led to increased use for cancer assessment, treatment, and monitoring. Although it has advantages over mammography, it also has potential limitations, which may lead to additional, unnecessary biopsies. Our purpose was to identify the histopathologic findings frequently present as abnormal lesions on breast MRI. A retrospective review was conducted on all patients who underwent MRI-guided core needle breast biopsy (MRI-CNBB) from January 2012 to December 2014 in our institution. Biopsies were performed using a 1.5 Tesla MR with a 9-, 12-, or 18-gauge vacuum-assisted core biopsy needle. Altogether 203 MRI-CNBB, performed in 153 patients, were reviewed. 40 patients had multiple biopsies (27%), of whom 9 patients had bilateral biopsies. Enhancing nodule or mass was the most common indication. Overall, 138 (68%) cases had benign breast findings, 31(15%) had atypical findings, and 34 (17%) had malignant findings. The most common benign diagnoses were proliferative fibrocystic changes comprising 33% of all benign findings. Other common benign diagnoses included breast tissue with/without fibrosis (26%), nonproliferative fibrocystic changes (18%), fibroadenoma, (8%), pseudoangiomatous hyperplasia (3%) and fat necrosis (7%). Less common findings were benign intramammary lymph node, duct ectasia, ruptured cyst, radiation changes, and papillary apocrine metaplasia. 48% of atypical findings were atypical ductal hyperplasia, followed by papillary neoplasm with atypia (22%), flat epithelial atypia (19%) and atypical lobular hyperplasia/lobular carcinoma in situ (LCIS; 16%). Malignant findings included 17 invasive ductal carcinoma (50%), 11 ductal carcinoma in situ (32%), 5 invasive lobular carcinoma/LCIS (15%) and 1 solid papillary carcinoma (3%). Our results are compatible with current literature findings, suggesting that MRI-CNBB targets benign lesions with specific histopathologic findings. The appropriate use of breast MRI is evolving, and some indications remain controversial.