International Cancer Conference Journal最新文献

The combination therapy of lenvatinib plus pembrolizumab (LP) is increasingly recognized as an important second-line regimen for advanced or recurrent endometrial cancer (EC). However, the safety and efficacy of conversion surgery with low anterior rectal resection for unresectable EC following LP therapy is unknown. A 37-year-old woman was referred with unresectable EC with pleural fluid, peritoneal dissemination, and ascites. After the failure of first-line platinum-based chemotherapy, she was administered LP as second-line treatment. After 10 treatment cycles, uterine and peritoneal tumors significantly reduced in size, except the left ovarian metastatic tumor which became slightly larger. Cytoreductive surgery, including low anterior resection of the rectum and colorectal anastomosis, achieved complete resection. However, on postoperative day 11, the patient experienced an anastomotic leakage around the colorectal anastomosis site, necessitating a double-barreled colostomy and percutaneous drainage. She was discharged 15 days after the second surgery and resumed LP therapy after 44 days following the second surgery. We report a case in which conversion surgery after LP therapy was conducted for unresectable advanced endometrial cancer. Our findings indicate that if bowel resection is required, a longer preoperative withdrawal period may be necessary to prevent postoperative anastomotic leakage.

Pulmonary sclerosing pneumocytoma (PSP) is a rare form of lung cancer that occasionally presents with lymph node and extrapulmonary metastases, and multiple lesions. The treatment of metastatic PSP remains undefined. This study reports the case of a 48-year-old female patient diagnosed with PSP following surgical intervention for a solitary nodule in the left lower lobe. Four years later, recurrence occurred in the left hilar and mediastinal lymph nodes, necessitating an additional resection. Concurrently, sacral metastases developed and required palliative radiotherapy. Genetic analysis identified an AKT1 E17K mutation, characteristic of PSP, and absence of programmed cell death ligand 1 (PD-L1) expression in the tumor. Two years post-recurrence, the tumor recurred in the left mammary gland and mediastinal lymph nodes. Combination immunotherapy with ipilimumab and nivolumab yielded a significantly positive response in this metastatic PSP case. This is the first reported case of successful treatment of multiple distant metastatic PSP with ipilimumab and nivolumab, following the failure of various local treatments. Further case series are warranted to validate the efficacy of immunotherapy in metastatic PSP.

Osimertinib has emerged as the standard first-line treatment for advanced non-small cell lung cancer (NSCLC) with EGFR mutations, offering improved tolerability and demonstrating superior efficacy against brain metastases in comparison with other tyrosine kinase inhibitors. The Meckel's cave is a dural recess in the posteromedial part of the middle cranial fossa that acts as a conduit for the trigeminal nerve between the anterior pontine cisterna and the cavernous sinus, and houses the Gasserian ganglion and proximal radicle of the trigeminal nerve. Trigeminal neuropathy, characterized by numbness and dysesthesia of the skin and mucous membranes of the face, poses diagnostic challenges and often requires differentiation from conditions, such as compression neuropathy, inflammation, and drug-induced reactions. Here, we report the case of Meckel's cave metastasis. She presented headache, anorexia, left facial numbness, and pain indicative of trigeminal neuropathy. Imaging revealed metastasis to Meckel's cave, consistent with her clinical symptoms. EGFR L858R mutation was detected by primary lesion of the lung DNA analysis. Treatment with osimertinib led to regression of the primary tumor and improvement of the trigeminal neuropathy within 3 months. Importantly, our review of the relevant literature identified only two similar cases with metastasis of lung adenocarcinoma to Meckel's cave. Ours was the only case in which symptom resolution was achieved. We underscore the utility of MRI and PET/CT studies in evaluating trigeminal-related symptoms and discuss imaging characteristics that may aid in their differentiation.

Foreign body granuloma (FBG) is an inflammatory reaction to an exogenous agent. This entity is well known on the cutaneous organ but very rarely described in the abdominal cavity. We report three clinical cases of intraperitoneal FBG following major debulking of pseudomyxoma and intraperitoneal hyperthermia chemotherapy. The symptoms of FBG were a prolonged postoperative ileus (POI) requiring complex repeat surgery. The intestine was retracted by fibrous tissue with several small granulomas at the center. The granulomatous reaction was established by histopathology and the foreign body was clearly and secondarily identified as gauze fibers. Such cases have never been described before and open discussion is needed about the obstruction mechanism, the role played by large peritonectomies, the impact of the COVID-19 epidemic on malfunctions in material devices usually considered safe, and methods to ensure patient safety.

Bone metastasis in the periacetabular region usually causes severe pain and functional disability. Some surgical procedures, such as the Harrington surgery and percutaneous cementoplasty, have been reported as treatment options for periacetabular bone metastases with limited efficacy. The former is highly invasive, while the latter may not allow the injection of a sufficient amount of cement. Here we report two surgical cases using a new modified surgical method (mini-open periacetabular cementoplasty: MO-PAC) consisting of tumor curettage and cementoplasty through a small incision.

A 41-year-old premenopausal woman presented to our hospital with lower abdominal distention and epigastralgia. An ovarian endometriotic cyst was noted when she was 30 years, and was only followed up until she was 36 years. Suspecting rupture of an ovarian tumor, left adnexectomy was performed. The left ovarian tumor was diagnosed as an ovarian carcinosarcoma of the heterologous type occurring in the endometriotic cyst. The carcinosarcoma was composed of an admixture of high-grade carcinomatous and sarcomatous components, including rhabdomyosarcoma. Thereafter, secondary surgery was concluded, which confirmed the tumor stage to be pT1c3. She postoperatively received 6 cycles of docetaxel/carboplatin as adjuvant chemotherapy and achieved recurrence-free survival for 40 months. Among ovarian carcinosarcomas, cases occurring in endometriotic cysts are particularly rare and may have a relatively good prognosis, because tumor cells, especially sarcoma components, tend to be confined to the ovaries. Pathological estimation of the origin of carcinosarcoma is important, because it appears to correlate with prognosis.

Mismatch repair deficiency (MMRd) or microsatellite instability high (MSI-H) is rare in prostate cancer and more frequently observed in cases with ductal histology. MLH1 copy number loss is extremely rare in MMRd tumors. Herein, we describe a case of prostate ductal adenocarcinoma with MLH1 copy number loss, microsatellite instability high and BRCA2 mutation could derive benefit from immunotherapy plus ADT. A 72-year-old Chinese patient was diagnosed with poorly differentiated prostate ductal adenocarcinoma mixed with acinar adenocarcinoma (Gleason 5 + 4). Next-generation sequencing (NGS) showed a hypermutated tumor with a mutational burden of 34.71 mutations per Mb and microsatellite instability high (MSI-H). Suspected biallelic MLH1 loss (copy number 0.16) and a pathogenic somatic BRCA2 variant (E2981Kfs*7) were detected. After surgery, the patient received androgen-deprivation therapy (ADT) with goserelin (10.8 mg every 3 months) and tislelizumab (200 mg every 3 weeks). At the 1-year follow-up, the PSA level was lower than 0.01 ng/ml and a pelvic MRI revealed no abnormalities. Our case highlights the intricate molecular mechanisms of MMRd prostate cancer.

First-bite syndrome (FBS) is manifested as acute and severe pain in the parotid region occurring at the first bite of a meal. While most cases of FBS arise after surgeries involving the deep lobe of the parotid gland, chemotherapy-induced FBS is extremely rare. Some adverse effects of oxaliplatin resemble FBS, suggesting it may be under-recognized. Here, we present a case of a 72 year-old male with oxaliplatin-induced FBS, effectively managed with the prophylactic administration of duloxetine hydrochloride. The patient, with a history of surgery for appendiceal adenocarcinoma, experienced sharp pain in the bilateral parotid regions at the beginning of each meal after the second to fourth courses of adjuvant chemotherapy with CapeOX (oxaliplatin and capecitabine). He was subsequently referred to our department for evaluation. Upon examination, no organic diseases were identified. Given the reproducible nature of the symptoms, oxaliplatin-induced FBS was diagnosed. We commenced prophylactic duloxetine hydrochloride before the fifth and sixth courses of chemotherapy, which significantly reduced the pain. After completing six courses of oxaliplatin, the patient no longer experienced symptoms of FBS, even without the continued administration of duloxetine hydrochloride. This case highlights that oxaliplatin can induce FBS, which can be effectively managed with duloxetine hydrochloride.

A 50-year-old man presented with a bulky mass in the left thigh and was referred to our department. He showed an impaired Eastern Cooperative Oncology Group performance status of 3 due to swelling of the left thigh and pain. Imaging analysis revealed a large mass measuring 16 cm in the left thigh and right forearm, along with the bilateral adrenal gland, right lung, right axillary lymph nodes, liver, and left femur. Despite additional tests, including pathological examination, the primary origin of the tumors could not be identified. Because of the rapid tumor progression, he was placed on nivolumab (NIVO; 240 mg/body, every 2 weeks) monotherapy based on the diagnosis of cancer of unknown primary, unfavorable type. Simultaneous comprehensive genomic profiling (CGP) test revealed a high tumor mutation burden (15.69 Muts/Mb) and a truncating mutation of SMARCA4, along with loss of BRG1 expression detected by additional immunohistochemical (IHC) analysis. Based on the predominance of soft tissue in the lesion, histological and IHC findings, and genomic phenotype, the patient was finally re-diagnosed with SMARCA4-deficient, SMARCB1/INI-1-preserved epithelioid sarcoma (ES). He showed a dramatic improvement in physical and laboratory findings at 5 weeks after the initial NIVO dose. Although he experienced immune-related adverse events, such as liver dysfunction, colitis and relative adrenal failure, and severe sepsis due to pulmonary cyst infection, he was able to overcome these complications. By the 12th dose of NIVO (13 months after the initial treatment), he has exhibited a positive response to NIVO without any additional complications. Among SMARCA4-deficient tumors, there have been multiple reports on the sensitivity of SMARCA4-deficient thoracic tumors to immune checkpoint inhibitors (ICIs), including PD-1 blockade agents. This case indicates that SMARCA4-deficient SMARCB1/INI-1-preserved ES may share molecular pathological characteristics with SMARCA4-deficient thoracic tumors, given their similar sensitivity to ICIs. In addition, CGP may play an important role in hypothesizing the primary site of tumors and guiding treatment selection for rare cancers, as in the present case, which lacks established treatment options. Further data accumulation is essential to validate this approach.

Hereditary hemorrhagic telangiectasia (HHT) is a rare genetic disorder characterized by refractory recurrent epistaxis and gastrointestinal bleeding. Recent studies have reported the hemostatic effects of tyrosine kinase inhibitors on HHT-related bleeding. A 67-year-old man with HHT underwent laparoscopic radical nephrectomy for right renal cell carcinoma discovered during an investigation of anemia. Five years after surgery, pancreatic metastasis with biliary dilatation was found on computed tomography. After a biliary stent was inserted, the patient was treated with cabozantinib plus nivolumab. His hemoglobin level significantly improved from 4.8 g/dL to a maximum of 14.7 g/dL, and transfusion frequency reduced from five to one per 5 months. Despite tumor reduction after 6 months of treatment, the patient developed acute cholangitis because of biliary hemorrhage, which ultimately resulted in hepatic failure and death. This case is the first to indicate the potential of the tyrosine kinase inhibitor cabozantinib to control bleeding and tumor progression in patients with metastatic renal cell carcinoma with HHT-related bleeding.