Docetaxel was effective in the management of metastatic angiosarcoma associated with disseminated intravascular coagulation syndrome

typical case of an immunocompromised district Editor, We read with interest the case report of a 52-year-old man with granulomatous cutaneous lesions that appeared on the remaining part of his amputated left forearm. The lesions were similar to those of granulomatous mastitis and associated with risperidone-induced hyperprolactinemia. According to the authors, the lesions occurred on the amputation stump (and not in the breasts, as had occurred in previously published cases) for three reasons: (i) breast tissue in males is not a target organ for prolactin; (ii) prolactin is often involved in immune-related skin disorders; and (iii) an amputated limb has an autonomic neuroendocrine environment, which differs from that in a normal limb or organ as a result of the severing of nerve endings and – we add – lymph collectors at the site. In our opinion, the last reason is the most important because the abrupt cutting off of nerve fibers and lymphatic vessels in the residual stump interrupts the neuroimmune interplay that normally regulates regional immune control. In fact, the local disruption of any cross-talk among neuromediators running along peripheral nerve fibers and immune competent cells conveyed by lymphatic vessels deprives the amputation stump of normal immunological functions and makes it a vulnerable district (immunocompromised district); it becomes a privileged site for the onset of opportunist infections, tumors, and dysimmune reactions. The case on which we comment here thus represents a typical instance of an immunocompromised district on an amputation stump, which harbored drug-induced and hyperprolactinemia-related lesions of granulomatous type. These lesions represent a dysimmune reaction which should be included in the list of many and various immune disorders that can arise on an amputated limb (Table 1).