Current problems in cancer. Case reports最新文献

英文中文

Acquired lipodystrophy following use of pembrolizumab 使用 Pembrolizumab 后获得性脂肪营养不良

IF 0.2 Q4 ONCOLOGY

Current problems in cancer. Case reports

Pub Date : 2024-10-31 DOI: 10.1016/j.cpccr.2024.100332

Maya Weitzen , Marcus DaSilva Goncalves , Shaheer Khan , Alexander Barbaro , Richard Carvajal , Keyur Thakar

This case report details a 65-year-old female with Hashimoto's hypothyroidism and stage III melanoma who developed acquired generalized lipodystrophy (AGL), a rare immune-mediated adverse event, following pembrolizumab treatment. The patient was initially treated with nivolumab but was switched to pembrolizumab after developing optic neuritis. After starting pembrolizumab, the patient experienced significant weight loss and lipoatrophy in the face, thighs, and buttocks, alongside hypertrophy of the fat pads in her axillae, supraclavicular, and suprapubic areas. The patient also exhibited symptoms of marked insulin resistance and hypertriglyceridemia, indicative of AGL. Pembrolizumab treatment was discontinued after the patient developed additional side effects including hepatitis, hypophysitis, and thyroiditis, and the patient was commenced on steroid therapy. The patients insulin resistance and hypertriglyceridemia subsequently improved. Genetic sequencing excluded a genetic cause for her lipodystrophy. This is the fourth case of a patient developing AGL following administration of pembrolizumab, and the third for advanced melanoma. Since pembrolizumab administration for treatment of advanced melanoma is becoming more common, it necessitates clinician awareness to potential, rare complications not commonly defined in initial clinical trials.

本病例报告详细描述了一名患有桥本氏甲状腺功能减退症和黑色素瘤 III 期的 65 岁女性患者在接受 pembrolizumab 治疗后出现获得性全身脂肪营养不良（AGL）这一罕见的免疫介导不良事件。患者最初接受的是 nivolumab 治疗，但在出现视神经炎后改用了 pembrolizumab。开始使用 pembrolizumab 后，患者体重明显下降，脸部、大腿和臀部出现脂肪萎缩，腋窝、锁骨上和耻骨上区域的脂肪垫肥厚。患者还表现出明显的胰岛素抵抗症状和高甘油三酯血症，这表明她患有 AGL。在患者出现肝炎、肾上腺皮质功能减退症和甲状腺炎等其他副作用后，彭博利珠单抗治疗被中止，患者开始接受类固醇治疗。患者的胰岛素抵抗和高甘油三酯血症随后得到改善。基因测序排除了导致其脂肪营养不良的遗传原因。这是第四例服用 Pembrolizumab 后出现 AGL 的患者，也是第三例晚期黑色素瘤患者。由于使用 pembrolizumab 治疗晚期黑色素瘤越来越常见，因此临床医生有必要认识到潜在的罕见并发症，这些并发症在最初的临床试验中并不常见。

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引用次数: 0

Adeno-squamous carcinoma of bartholin gland: Challenges in diagnosis and management of a less known vulvar cancer – A case report 巴氏腺鳞癌：鲜为人知的外阴癌的诊断和治疗难题 - 病例报告

IF 0.2 Q4 ONCOLOGY

Current problems in cancer. Case reports

Pub Date : 2024-10-18 DOI: 10.1016/j.cpccr.2024.100330

Sarita Kumari , Ruchi Rathore , Abhinav Singhal , Haritha Maddirala , Sandeep Mathur , Neerja Bhatla

Bartholin gland carcinoma is one of the less common histology accounting for 0.1 – 5 % of all vulvar malignancies and is mostly seen in postmenopausal women. It accounts for 0.001 % of all female malignancies. Clinical presentation is delayed to its deep-seated position in vulva. It has a propensity for frequent recurrences and distant metastases. Owing to the disease rarity, there are no well-defined management guidelines. We describe here the challenges in diagnosis and management of a case of adeno-squamous carcinoma of bartholin gland in a postmenopausal woman. Unlike the usual presentation, our case presented in an early stage with symptom of itching per vaginum. Radical surgery was the primary treatment modality with no requirement for adjuvant treatment and the patient is disease free at two years post treatment. However, adeno-squamous carcinoma of vulva has a propensity for perineural invasion and early nodal metastases and a dismal five-year survival.

巴氏腺癌是一种不太常见的组织学类型，占所有外阴恶性肿瘤的 0.1 - 5%，多见于绝经后妇女。它占所有女性恶性肿瘤的 0.001%。临床表现因其位于外阴深部而延迟。它有频繁复发和远处转移的倾向。由于该病罕见，目前尚无明确的治疗指南。我们在此描述一例绝经后妇女的巴氏腺鳞癌诊断和治疗过程中遇到的挑战。与通常的病例不同，我们的病例早期即出现阴道瘙痒症状。根治性手术是主要的治疗方式，不需要辅助治疗，患者在治疗后两年无病。然而，外阴腺鳞癌容易发生会阴周围浸润和早期结节转移，五年生存率很低。

引用次数: 0

Prolonged survival in postoperative recurrent EGFR-L858R NSCLC: A 24-year case report 延长 EGFR-L858R NSCLC 术后复发患者的生存期：长达 24 年的病例报告

IF 0.2 Q4 ONCOLOGY

Current problems in cancer. Case reports

Pub Date : 2024-10-18 DOI: 10.1016/j.cpccr.2024.100329

Yoshihiro Go , Chinatsu Yoshizaki , Yuki Yoshida , Shiho Nohmi , Rui Kusakado , Yuichiro Saito , Kensuke Izumizaki , Takafumi Ogawa , Takashi Suzuki , Fumihiro Yamaguchi

The use of epidermal growth factor receptor-tyrosine kinase inhibitors (EGFR-TKIs) is well-established for the treatment of advanced non-small cell lung cancer (NSCLC) patients with activating EGFR mutations. In this study, we report the long-term efficacy of EGFR-TKI therapy in a patient with postoperative recurrent NSCLC. A 58-year-old Japanese woman experienced recurrence after surgery, and an EGFR L858R mutation was identified. The patient continued gefitinib therapy for over 13 years, achieving a long-term survival of 21 years after postoperative recurrence, and 24 years after the initial diagnosis. This is the first report of a long-term response to EGFR-TKI therapy in an NSCLC patient with an L858R mutation. This case suggests the potential effectiveness of combining local therapy with EGFR-TKI treatment for metachronous oligometastatic disease.

表皮生长因子受体-酪氨酸激酶抑制剂（表皮生长因子受体-TKIs）用于治疗表皮生长因子受体突变活化的晚期非小细胞肺癌（NSCLC）患者的疗效已得到广泛认可。在本研究中，我们报告了一名术后复发 NSCLC 患者接受 EGFR-TKI 治疗的长期疗效。一位58岁的日本女性患者术后复发，并发现了表皮生长因子受体（EGFR）L858R突变。该患者持续接受吉非替尼治疗超过13年，术后复发后长期存活21年，距最初诊断24年。这是第一份关于L858R突变的NSCLC患者对EGFR-TKI治疗长期应答的报告。该病例表明，将局部治疗与表皮生长因子受体-TKI治疗相结合，对转移性寡转移疾病具有潜在疗效。

引用次数: 0

Refractory chronic lymphocytic leukemia with concomitant extramedullary multiple myeloma with lymph node involvement 难治性慢性淋巴细胞白血病合并淋巴结受累的髓外多发性骨髓瘤

IF 0.2 Q4 ONCOLOGY

Current problems in cancer. Case reports

Pub Date : 2024-10-18 DOI: 10.1016/j.cpccr.2024.100324

Piotr Jachimowski , Łukasz Ciulkiewicz , Bogna Ziarkiewicz-Wróblewska , Laretta Grabowska-Derlatka , Grzegorz Basak , Mateusz Ziarkiewicz

Concomitant chronic lymphocytic leukemia (CLL) and multiple myeloma (MM) in the same patient is extremely rare. In this report, we present an unprecedented case of a patient with a history of progressive, purine analog-resistant CLL, who developed extramedullary malignant plasmacytic infiltrates in lymph nodes on the background of preexisting CLL lesions, presenting with clinical sequelae attributable to active MM (hypercalcemia, renal insufficiency, anemia, bone lesions). We administered R-CHOP with bortezomib with partial remission and both CLL and MM relapsed after one month. Our patient deceased three months later. Surprisingly first bone marrow trephine biopsy did not reveal plasmacytic infiltration. However combination of symptoms presented by our patient should always be an indication for repeating biopsy. Early detection of aggressive multiple myeloma can improve prognosis and prolong survival.

同一患者同时患有慢性淋巴细胞白血病（CLL）和多发性骨髓瘤（MM）的情况极为罕见。在本报告中，我们发现了一例史无前例的病例，患者曾患有进展性、嘌呤类似物耐药的 CLL，在原有 CLL 病变的背景下，淋巴结出现髓外恶性浆细胞浸润，并伴有活动性 MM 的临床后遗症（高钙血症、肾功能不全、贫血、骨病变）。我们给予硼替佐米联合 R-CHOP 治疗，患者病情部分缓解，但一个月后 CLL 和 MM 均复发。三个月后，我们的病人去世了。令人惊讶的是，第一次骨髓穿刺活检并未发现浆细胞浸润。然而，我们的患者所出现的综合症状始终是重复活检的指征。早期发现侵袭性多发性骨髓瘤可以改善预后，延长生存期。

引用次数: 0

Anaphylaxis from filgrastim prophylaxis within the same day of chemotherapy: A case report 化疗当天服用非格司亭预防药物引发过敏性休克：病例报告

IF 0.2 Q4 ONCOLOGY

Current problems in cancer. Case reports

Pub Date : 2024-10-17 DOI: 10.1016/j.cpccr.2024.100328

Suluck Soontaros , Supaporn Wongduang , Nattawut Leelakanok

Introduction

Filgrastim is recommended to be used 24–72 h after the last dose of chemotherapy for the prophylaxis of febrile neutropenia. However, several studies demonstrate the efficacy and safety of the use of filgrastim within the same day of the last dose of chemotherapy.

Case presentation

We presented a patient with state IIIC immature teratoma at her right ovary who was treated with the BEP regimen. She received 10 doses of filgrastim per BEP cycle to prevent febrile neutropenia. On the first BEP cycle, the first dose of filgrastim was used within 24 h after the last chemotherapy dose and dyspnea was developed. On the second cycle of BEP, filgrastim was still used as the same-day regimen. One hour after the first dose of filgrastim, anaphylaxis occurred and the patient was treated appropriately. The second dose of filgrastim can be rechallenged successfully and filgrastim can be finished without any adverse events. On the third and fourth cycles of BEP, filgrastim was used as the next-day regimen (interval longer than 24 h). There were no adverse events that occurred during the use of filgrastim.

Conclusion

The residual chemotherapy may increase the risk of anaphylaxis induced by filgrastim via a non-IgE-mediated mechanism in this case patient.

导言：为预防发热性中性粒细胞减少症，建议在最后一次化疗后24-72小时使用非格司亭。我们接诊了一名右卵巢IIIC级未成熟畸胎瘤患者，她接受了BEP方案治疗。为了预防发热性中性粒细胞减少症，她在每个BEP周期接受了10剂filgrastim治疗。在第一个 BEP 周期，第一剂菲格拉司汀是在最后一次化疗用药后 24 小时内使用的，结果出现了呼吸困难。在第二周期的BEP治疗中，菲格司汀仍作为当天的治疗方案使用。第一次使用非格司亭一小时后，过敏性休克发生，患者接受了适当治疗。第二剂菲格拉司汀可成功再注射，菲格拉司汀可在无任何不良反应的情况下用完。在第三和第四个 BEP 周期中，菲格司汀被用作次日用药（间隔时间超过 24 小时）。结论在本例患者中，残余化疗可能会通过非IgE介导的机制增加非格司亭诱发过敏性休克的风险。

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引用次数: 0

Refractory IgM AL amyloidosis with massive soft tissue tumors: Rescue with zanubrutinib. A case report 难治性IgM AL淀粉样变性伴巨大软组织肿瘤：扎努布替尼的救治。病例报告

IF 0.2 Q4 ONCOLOGY

Current problems in cancer. Case reports

Pub Date : 2024-10-12 DOI: 10.1016/j.cpccr.2024.100325

Piotr Jachimowski , Łukasz Ciulkiewicz , Mateusz Ziarkiewicz , Bogna Ziarkiewicz-Wróblewska , Marta Legatowicz-Koprowska , Krzysztof Jamroziak

Waldenström macroglobulinemia (WM) is a rare indolent B-cell non-Hodgkin lymphoma with lymphoplasmacytic morphology, associated with immunoglobulin M (IgM) monoclonal gammopathy. The coexistence of WM and immunoglobulin light chain (AL) amyloidosis is an uncommon but well-described phenomenon. In patients suffering from IgM AL amyloidosis soft tissue involvement and neuropathy are more prevalent in comparison to non-IgM patients. We present a case of 82-year old female with WM and intercurrent IgM AL amyloidosis, presenting with massive amyloidomas of both lower extremities, without significant cardiac and renal involvement. The patient was refractory to several lines of treatment and finally started on zanubrutinib monotherapy, with rapid and sustained very good partial hematologic response (VGPR) and clinical improvement.

瓦尔登斯特伦巨球蛋白血症（WM）是一种罕见的非霍奇金B细胞淋巴瘤，具有淋巴浆细胞形态，伴有免疫球蛋白M（IgM）单克隆性腺病。WM与免疫球蛋白轻链（AL）淀粉样变性同时存在，这种现象并不常见，但已被详细描述。与非 IgM 患者相比，IgM AL 淀粉样变性患者的软组织受累和神经病变更为普遍。我们报告了一例82岁的女性患者，她患有WM和并发症IgM AL淀粉样变性，双下肢出现大量淀粉样变瘤，但没有明显的心脏和肾脏受累。患者对多种治疗方法均无效，最后开始接受扎鲁替尼单药治疗，并获得了快速、持续的非常好的部分血液学反应（VGPR）和临床改善。

引用次数: 0

Unusual presentation of melena due to duodenal metastasis from primary lung adenocarcinoma 原发性肺腺癌十二指肠转移引起的血性腹泻的异常表现

IF 0.2 Q4 ONCOLOGY

Current problems in cancer. Case reports

Pub Date : 2024-10-11 DOI: 10.1016/j.cpccr.2024.100326

Gülden Bilican , Serkan Dumanlı , Ercan Yıldırım , Ali Karataş , Ayşenur Sert , Ozan Yazıcı

We present a rare case of duodenal metastasis from primary lung adenocarcinoma, emphasizing the diagnostic challenges and treatment considerations associated with this uncommon metastatic presentation. Through this case report, we aim to enhance awareness of this clinical entity and highlight the importance of multidisciplinary collaboration in its management.

我们介绍了一例原发性肺腺癌十二指肠转移的罕见病例，强调了与这种不常见的转移表现相关的诊断挑战和治疗注意事项。通过本病例报告，我们希望提高人们对这一临床实体的认识，并强调多学科合作在治疗中的重要性。

引用次数: 0

Definitive chemoradiotherapy with Carboplatin Plus Paclitaxel for Unresectable Locally Advanced Thymic Carcinoma: A case series 用卡铂加紫杉醇对无法切除的局部晚期胸腺癌进行确定性化放疗：一个病例系列

IF 0.2 Q4 ONCOLOGY

Current problems in cancer. Case reports

Pub Date : 2024-09-17 DOI: 10.1016/j.cpccr.2024.100323

Koichiro Nozaki, Satoshi Watanabe, Ryo Yamazaki, Masashi Arita, Toshiaki Kikuchi

Objectives

Thymic carcinoma (TC) is rare. There is no evidence regarding the treatment strategies for unresectable locally advanced thymic carcinomas. Definitive chemoradiotherapy may treat this condition. However, an appropriate concurrent chemotherapy with radiotherapy has not yet been established.

Materials and methods

We present three cases of locally advanced thymic carcinoma treated with definitive chemoradiotherapy using carboplatin and paclitaxel.

Results

Three patients aged 74–81 with Masaoka stage III thymic carcinoma were included. One patient was a woman, and two patients were men. All patients received weekly carboplatin (area under the curve, 2) plus paclitaxel (40 mg m^-12) and concurrent radiotherapy (60 Gy). One patient experienced an adverse event of grade 3 radiation pneumonitis after chemoradiotherapy, but the three patients completed chemoradiotherapy with minor adverse events during treatment. Progression-free survival after chemoradiotherapy was 59+, 24+, and 16+ months, respectively; all patients were alive.

Conclusion

Definitive concurrent chemoradiotherapy with weekly carboplatin plus paclitaxel may be effective for treating unresectable locally advanced thymic carcinomas.

目的胸腺癌（TC）非常罕见。对于无法切除的局部晚期胸腺癌，目前尚无治疗策略的证据。确定性放化疗可治疗这种疾病。材料与方法我们报告了三例使用卡铂和紫杉醇进行确定性化放疗治疗的局部晚期胸腺癌病例。其中一名患者为女性，两名患者为男性。所有患者均接受每周一次的卡铂（曲线下面积为 2）加紫杉醇（40 mg m-12）治疗，并同时接受放疗（60 Gy）。一名患者在放化疗后出现了 3 级放射性肺炎的不良反应，但三名患者在完成放化疗的过程中均未出现轻微不良反应。化放疗后的无进展生存期分别为59+个月、24+个月和16+个月；所有患者均存活。

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引用次数: 0

Use of anamorelin hydrochloride in a patient with lung cancer-related cachexia undergoing chemoradiotherapy: A case report 在接受化疗放疗的肺癌相关恶病质患者中使用盐酸阿那莫林：病例报告

IF 0.2 Q4 ONCOLOGY

Current problems in cancer. Case reports

Pub Date : 2024-09-12 DOI: 10.1016/j.cpccr.2024.100322

Haruka Fujioka , Kei Nakashima , Nana Munakata , Shigenori Yamamoto , Reina Idemitsu , Taiki Kawai , Kentaro Tochigi , Yasuhiro Morimoto , Hiroyuki Ito , Ayumu Otsuki

This report describes the case of a 59-year-old man with poorly differentiated lung adenocarcinoma and cachexia who completed chemoradiation therapy for stage III lung cancer following the administration of anamorelin. Anamorelin, a ghrelin receptor agonist, effectively improved his appetite and performance status, thereby enabling the continuation of treatment. The role of anamorelin in enhancing appetite during acute-phase treatment is promising; however, further studies must be conducted to elucidate its interaction with chemoradiation therapy. This case report highlights the potential of anamorelin as a therapeutic option for the management of cancer-related cachexia during curative treatment for lung cancer.

本报告描述了一名患有分化不良肺腺癌并伴有恶病质的 59 岁男子的病例，他在服用阿那莫瑞林（anamorelin）后完成了 III 期肺癌的化疗。阿那莫瑞林是一种胃泌素受体激动剂，能有效改善他的食欲和表现状况，从而使治疗得以继续。阿那莫瑞林在急性期治疗中增进食欲的作用令人鼓舞；然而，还必须开展进一步研究，以阐明其与化疗放疗的相互作用。本病例报告强调了阿那莫瑞林作为治疗肺癌根治性治疗期间癌症相关恶病质的一种治疗选择的潜力。

引用次数: 0

Stauffer syndrome in a tumor of the pancreatic tail: A paracrine pathogenesis, rather than an inflammatory disimmune phenomenon – a case report 胰腺尾部肿瘤引发的 Stauffer 综合征：旁分泌型发病机制，而非炎症性免疫失调现象--病例报告

IF 0.2 Q4 ONCOLOGY

Current problems in cancer. Case reports

Pub Date : 2024-09-01 DOI: 10.1016/j.cpccr.2024.100320

Caterina Porciani , Piero Colombatto , Simone Guadagni , Gabriele Ricco , Luca Morelli , Laura Caponi , Daniela Campani , Annalisa Comandatore , Giusi Desire' Sciume' , Paola Migliorini , Piero Boraschi , Maurizia Brunetto , Giulio Di Candio

Stauffer syndrome, also known as paraneoplastic intrahepatic cholestasis syndrome, is a rare reversible clinical manifestation characterized by elevation of direct bilirubin, alcaline phosphatase, transaminases and prolonged prothrombin time, without direct hepatobiliary disease, that is due to the presence of malignancy, mostly kidney cancer. In this case report, we describe a rare form of mixed acinar neuroendocrine pancreatic tail mass causing a non-obstructive form of cholestasis. We analysed the effects of metilprednisolone treatment and surgery on the levels of interleukin-6 (IL-6) and tumor necrosis factor alpha (TNF alpha), previously associated with this syndrome. We found that serum levels of IL-6 and TNF alpha decreased during steroid treatment, had a peak immediately after the surgical procedure, and remained stable while cholestasis resolved slowly after tumour removal. These findings showed that IL-6 and TNF alpha were not the effectors of the paraneoplastic cholestasis in our patient. Rather, the evidence of a mixed acinar neuroendocrine pancreatic tumour and non-specific cholestasis at the liver histology suggests paracrine mechanisms affecting cellular transporters implicated in bile acids excretion.

Stauffer 综合征又称副肿瘤性肝内胆汁淤积综合征，是一种罕见的可逆性临床表现，以直接胆红素、碱性磷酸酶、转氨酶升高和凝血酶原时间延长为特征，无直接肝胆疾病，是由恶性肿瘤（多为肾癌）引起的。在本病例报告中，我们描述了一种罕见的混合性尖腺神经内分泌胰腺尾部肿块引起的非梗阻性胆汁淤积。我们分析了甲泼尼龙治疗和手术对白细胞介素-6（IL-6）和肿瘤坏死因子α（TNF α）水平的影响。我们发现，在类固醇治疗期间，血清中的IL-6和TNF alpha水平下降，在手术后立即达到峰值，并在肿瘤切除后胆汁淤积症缓慢缓解时保持稳定。这些研究结果表明，IL-6 和 TNF alpha 并不是我们患者副肿瘤性胆汁淤积症的致病因子。相反，在肝脏组织学上，混合性尖腺神经内分泌胰腺肿瘤和非特异性胆汁淤积的证据表明，旁分泌机制影响了胆汁酸排泄中的细胞转运体。

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