Current problems in cancer. Case reports最新文献

Background

Occult breast cancer (OBC) is an uncommon diagnosis that rarely causes skin metastasis. Our aim herein was to report a case of OBC with cutaneous metastasis and to systematically review the current evidence on the investigation, diagnosis, and treatment of such cases.

Methods

We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). A comprehensive search was conducted on MEDLINE, Embase, Cochrane Library, and Google Scholar. We included studies in English published from inception to August 2022 that included male or female patients who presented with OBC metastasis to the skin and that reported clinical outcomes of interest.

Results

We identified 854 articles, 13 of which were included in our review. The articles were case reports published between 2009 and 2022 and included 13 patients. The commonest site for skin lesions was the chest (n = 7), followed by the axilla (n = 5), of which 2 were bilateral. The skin lesions were nodular in 5 cases, macular in 2 cases, urticarial in 2 cases, papular in 1 case, and ulcerating in 2 cases. Skin metastasis was positive for estrogen receptor in 8 cases, progesterone receptor in 7 cases, cytokeratin 7 in 6 cases, and GATA binding protein 3 in 5 cases. Medical management was mostly by chemotherapy (n = 7) and hormonal therapy (n = 3). Surgical excision of the skin lesion was performed in 5 cases.

Conclusion

Cutaneous breast metastasis in the absence of the primary lesion is a rare phenomenon. Most cases reviewed were managed with multimodal approach including surgical and medical management. This review provides reference for physicians coming across similar cases.

Alpelisib is currently the only Phosphatidylinositol 3-kinase (PI3K) inhibitor approved for treating endocrine therapy-resistant metastatic breast cancer with a Phosphatidylinositol-4,5-bisphosphonate 3-kinase catalytic subunit alpha (PIK3CA)-mutation. Significant side effects of treatment include hepatotoxicity, hyperglycemia, diarrhea, nausea, stomatitis, fatigue, anorexia, and rash. We discuss the case of a 71-year-old woman with PI3K-mutated metastatic breast cancer and diabetes who presented with abdominal pain, nausea, and anorexia. She was started on alpelisib 250 mg daily four days before the hospital presentation. Notable labs at presentation included a glucose of 537 mg/dL and intrinsic renal acute kidney injury (AKI) with a creatinine of 1.6 mg/dL (baseline 1.2–1.3 mg/dL). A Computed Tomography (CT) scan was suggestive of typhlitis/colitis. After excluding other causes of hyperglycemia, she was diagnosed with alpelisib-induced hyperglycemia. Hyperglycemia with alpelisib is often severe and should prompt immediate consultation with endocrinology. Sodium-glucose co-transporter (SGLT) -2 inhibitors have been the most studied. However, concurrent kidney injuries may limit their real-world application. Alpelisib-associated complications subjected our patient to additional imaging, antibiotics, and prolonged hospital stay (6 days). The overall survival is not significantly increased with alpelisib as per the currently available data. More prospective trials will help assess and balance this drug's safety/efficacy profile to achieve better outcomes.

Immune checkpoint inhibitors (ICIs) are indispensable agents that may improve the long-term prognosis of non-small cell lung cancer. However, clinicians should always be aware that its immune-modulating mechanism of action may lead to unexpected immune-related adverse events (irAE). We report here a case of a 72-year-old man with adenocarcinoma of the lung who achieved a complete response to nivolumab plus ipilimumab plus chemotherapy but also suffered from a variety of immune-related adverse events. In this patient, Th1 immunity, which is involved in antitumor immunity, and Th2 immunity were activated, resulting in allergy-related reactions, including increased airway hyperresponsiveness and a marked increase in serum IgE levels. After starting corticosteroids, the allergic symptoms were well controlled. Remarkably, despite discontinuing ICI treatment, the patient has maintained a complete response for 27 months. Fortunately, we obtained lung and lymph node tissues from this patient after ICI administration and histologically examined the Th1 and Th2 immune status.

Background

Case presentation: In this study, we presented an Iranian female with triple-negative breast cancer that developed acro-metastasis to the hand

Conclusions

However, bone metastasis is the most common kind of neoplasm extension that we can witness in the breast cancer, acro-metastasis to the hand is an extremely rare kind of bone metastasis that we can expect.

Actinic keratoses are common pre-malignant lesions of the skin that have been documented to become inflamed after the use of chemotherapy. Several agents, such as 5-fluorouracil, capecitabine, pentostatin, dactinomycin, vincristine, dacarbazine, cytarabine, 6-thioguanine, sorafenib, paclitaxel, and docetaxel have been documented to cause this reaction. This case report aims to describe the inflammation of actinic keratoses in response to docetaxel plus cyclophosphamide. A 64-year-old woman undergoing chemotherapy for breast cancer presented to the clinic with multiple scaly, erythematous papules covering her shoulders, arms, chest, and back. This occurred 15 days after treatment with IV docetaxel plus cyclophosphamide. The results of the shave biopsies done at the visit were consistent with inflammation. She was treated with topical triamcinolone ointment and the inflammation greatly improved within one month. The inflammation was completely resolved two months after completing therapy with docetaxel plus cyclophosphamide. Documentation of cutaneous adverse events help provide awareness of this reaction and thereby prevent cessation of necessary cancer treatments. Further research is needed to determine which patients undergoing chemotherapy may be susceptible to inflammation of actinic keratoses.

In the last few years, non-small cell lung cancer (NSCLC) treatment has totally revolutionized by the improvement in molecular diagnostics and the introduction of targeted therapies, becoming the standard of care in patients with actionable alterations. Mostly, genomic mutations are mutually exclusive although some cases of co-occurring actionable alterations could be discovered, especially with the recent introduction of genomic sequencing by next generation sequencing (NGS). Few data are available in the treatment of these particular cases. The co-occurring RAS G12C mutation seems to be a poor prognostic factor in patients with ALK rearranged NSCLC. We report two cases of women with diagnosis of advanced adenocarcinoma oncogene addicted with ALK rearrangement and KRAS G12C mutation. In both cases the PD-L1 status was high (> 50 %). Although both received Alectinib as ALK inhibitor, the lesion rapidly progressed. The patients had benefit only by treatments with chemotherapy, while anti PD-1/PD-L1 axis inhibitors seemed to be inefficient. Precise diagnostic techniques allow the detection of concomitant driver alterations; therefore, oncologists should consider these rare double mutations in NSCLC patients. Further prospective study is still warranted to investigate the role of co-occurring driver alterations and the relevant treatment paradigm

Standard of care for patients with early-stage breast cancer typically does not use systemic surveillance or imaging studies following the administration of definitive treatment. However, the use of a circulating tumor DNA (ctDNA) test may provide an opportunity for early detection of cancer recurrence, particularly in patients with high-risk or aggressive forms of the disease. We present two cases of early-stage triple-negative breast cancer (TNBC) in which ctDNA screening facilitated early detection of recurrence prior to detection by imaging. As a result, treatment was initiated sooner than would have been possible in the absence of ctDNA screening.

These cases underscore the potential utility of ctDNA screening integration within a radiation oncology practice for the detection of recurrent breast cancer, and how their use in routine clinical practice could benefit patients. We also provide a review of the current literature on ctDNA testing, including its benefits and limitations. While there is currently insufficient data to support the routine use of ctDNA screening in all patients, we speculate on specific patient populations that may derive the greatest benefit from this innovative diagnostic tool.

Background

For mismatch repair protein deficient (dMMR) endometrial cancer (EC), first line therapy remains platinum-based chemotherapy. For dMMR EC that has progressed on standard first line platinum containing chemotherapy, treatment with programmed death ligand-1 (PD-1) inhibitors such as pembrolizumab have become integral to second line therapy. The challenging question remains, however, what the next best step is when these treatments fail.

Case

Here we report the case of a 71-year-old female who developed disease recurrence more than 20 years after surgical treatment for early stage dMMR endometrioid EC, with subsequent progression of disease on second line pembrolizumab therapy; however displayed excellent response to third line treatment with lenvatinib and pembrolizumab.

Conclusion

Consensus regarding third line treatment for patients with dMMR EC who progress on single agent PD-1 inhibitors after platinum-based chemotherapy failure remains unclear. While single agent pembrolizumab has demonstrated the greatest efficacy for dMMR disease, this case demonstrates a patient who had progression of disease on single agent pembrolizumab, however had excellent response with combination pembrolizumab and lenvatinib. Further study is warranted to assess the efficacy of this regimen for advanced or recurrent dMMR EC.

Epithelioid angiosarcoma involving the lung is a rare entity that can present with nodules or consolidations on CT imaging. We describe the case of a 23-year-old woman who presented with chronic cough and pleuritic chest pain and consolidations on CT chest who ultimately underwent diagnostic biopsy. A high index of suspicion is required for this disease, and biopsy is essential for the diagnosis of angiosarcoma. Histological evaluation and immunohistochemical analysis are helpful for the diagnosis of epithelioid angiosarcoma, and expression of CD31 is supportive of the diagnosis.

Hypercalcemia is a common paraneoplastic syndrome. Malignancies cause hypercalcemia by various mechanisms. Usually a single mechanism underlies paraneoplastic hypercalcemia. Two simultaneous mechanisms associated with one malignancy, however, are occasionally encountered. Here a rare case is reported to describe simultaneous PTHrp- and calcitriol-mediated hypercalcemia associated with probable spontaneous transformation of lung adenocarcinoma to squamous cell carcinoma. This 81-year-old male with history of resected lung adenocarcinoma developed hypercalcemia. The peak albumin-corrected calcium was 13.4 mg/dL (normal 8.6–10.4) with ionized calcium 1.70 mmol/L (normal 1.09–1.29). Laboratory tests showed PTH 7 pg/ml (normal 11–51), PTHrP 43.7 pmol/L (normal <2.3), 25-hydroxyvitamin D 33 ng/ml (normal 20–50), 1,25-dihydroxyvitamin D 71.0 pg/ml (19.9–79.3), TSH 3.1 µIU/mL (normal 0.3–4.7). CT showed new right lower lobe lung masses, paraesophageal and pericaval lymph nodes, and a cranial lesion. Biopsy of a lung mass revealed predominantly squamous cell carcinoma. He was treated with intravenous fluid and zoledronate with normalization of calcium levels. Vitamin D supplement was discontinued. The patient's clinical condition deteriorated before chemotherapy was started. He died shortly after comfort care was initiated. Pursuing multiple causes of paraneoplastic hypercalcemia is worthwhile as the treatment towards each mechanism is different.