Current problems in cancer. Case reports最新文献

Immunodeficiency is associated with higher cancer incidence, especially in transplanted patients; however, it is unknown whether there is a link between immunodeficiency and the development of multiple primary malignancies. Immunosuppressive drugs may either indirectly potentiate the effect of carcinogens or directly damage the DNA. Skin cancers are the most common malignancies diagnosed in renal transplant recipients. Management of immunosuppression in recipients of transplants who are living with cancer is complex and challenging. A concerted approach between transplant professionals, oncologists, and allied health professionals is therefore needed to ensure optimal care for transplant recipients who are developing immunodeficiency-induced malignancies. Here, we report a challenging case that presented with two simultaneous malignancies (buccal squamous cell carcinoma and gastric Burkitt's-like lymphoma) after nine years of being on immunosuppressants after the kidney transplant. The patient tolerated his cancer treatments with some grade II-III toxicities and is currently a two-year disease-free survivor. Focusing on the curative intent approaches for the two cancers with the adjustment of the immunosuppressant medications, besides the complications associated with these radical treatments, is worthy of being presented to the transplant and oncology teams globally.

Endometrial cancer remains the most common gynecologic malignancy in the United States. Novel molecular targets are being explored for treatment of advanced uterine. Molecular targets in signaling cascades have been identified including immune checkpoint inhibitors. This is a case of 63-year-old G0 with locally advanced unstaged undifferentiated/dedifferentiated TMB-H/MSI endometrial cancer, who had progression of disease after neoadjuvant radiation therapy. She was intolerant of systemic chemotherapy and declined surgical intervention but had subsequent complete response after 9 cycles of pembrolizumab. She has remained disease free for a total of 30 months (about 2.5 years) of follow up. Standard of care for advanced uterine cancer includes multimodality treatment with surgery, radiation, and systemic chemotherapy. This patient's response to treatment demonstrates that immunotherapy as an upfront treatment may be a reasonable alternative for patients with endometrial cancer with specific molecular profile regardless of histology.

Merkel Cell Carcinoma (MCC) of the breast is extremely rare, representing less than 1 % of all breast cancers. A 59-year-old woman with severe primary progressive multiple sclerosis (MS), on glatiramer acetate (Copaxone), presented with 1 month of progressive right breast swelling. Ultrasound revealed a large, irregular mass with associated dermal thickening; a subsequent ultrasound-guided biopsy was performed, revealing pathological features of MCC. A staging PETCT showed evidence of widely metastatic disease. MCC is associated with immunocompromised status and reactivation of Merkel Cell Polyomavirus. Interestingly, MS is associated with Epstein Barr Virus. The relationships between viruses, immune system dysfunction, and immune-modulating drugs - such as those to treat MS - require further research.

Among cases of non-small cell lung cancer (NSCLC) with EGFR mutations, NSCLC with deletions in EGFR exon 19 or 21 L858R account for 85 %. Frequency of NSCLC with minor mutations in EGFR is about 9 %, whilst EGFR exon 20 insertion mutation account for 6 % of the cases, determining it as a rare mutation. In this case, minor EGFR mutation and compound mutation EGFR H773L/V774M, were detected. Oncomine Dx target test (Oncomine), FoundationOne, and Amoy Dx polymerase chain reaction panel (Amoy 9-in-1 kit) were used as companion diagnostic tests. FoundationOne was the only one able to detect EGFR exon 20 H773L/V774M mutations. Drug therapy for NSCLC with compound mutations in EGFR exon 20 is not yet established. Unsuccessful treatments with EGFR-TKIs such as Erlotinib, Gefitinib, and Afatinib have been reported. There have also been reports of successful treatments with Osimertinib in combination with Bevacizumab. In the presented case, Osimertinib monotherapy was successful in treating NSCLC with EGFR exon 20 compound mutation. Osimertinib, therefore, has the potential to treat NSCLC with EGFR exon 20 H773L/V774M mutation, and can be a key drug for treating EGFR rare mutations.

Carcinoma of unknown primary (CUP) is a malignancy without a clinically identified site of primary occurrence despite an appropriate diagnostic workup. CUP portends a poor prognosis with median overall survival ranging between 4–9 months. The utilization of cell-free DNA (cfDNA) for characterizing disease-site specific methylation signatures has, to date, been limited. We report a series with five participants with CUP from the Oregon Health and Science University (OHSU) who were enrolled in a study utilizing a multi-cancer early detection (MCED) test using cfDNA to detect the primary malignancy. The observations from our case series suggest that the utility of cfDNA should be further explored in patients with CUP, and a large prospective trial is needed.

Immune checkpoint inhibitors (ICIs) have revolutionized the field of oncology and transformed the management of many malignancies, especially for patients with metastatic disease. Dermatologic toxicities are among the most common immune-related adverse events (irAEs) of ICIs and can manifest in various ways. We report the case of a 56-year-old male with metastatic colorectal cancer treated with ipilimumab and nivolumab who then developed dermatologic abnormalities confined to the blue-ink regions of his long-standing multicolored tattoos on multiple areas of his body. The patient's reaction resolved after intralesional injection of triamcinolone acetonide. Tattoo reactions associated with ICI treatment are rare, and to our knowledge, there have been no published cases of dermatologic irAEs isolated to blue-pigmented areas of multicolored tattoos. It is of great importance to have awareness of the possibility of this type of reaction and to provide appropriate care for patients undergoing treatment with ICIs.

Acute kidney injury (AKI) due to delayed methotrexate (MTX) elimination is a severe potential adverse event of high-dose (HD)-MTX treatment. However, no treatment for HD-MTX-induced AKI has been established. In addition, there are no reports of corticosteroids being administered for HD-MTX-induced AKI. Here, we report the case of a 77-year-old male with central nervous system lymphoma, who developed an AKI after the second course of HD-MTX. He underwent charcoal hemoperfusion and hemodialysis immediately after the development of the AKI. He also received short-term corticosteroid therapy due to inflammatory findings and a positive drug-induced lymphocyte stimulation test for MTX. Our case suggests that short-term corticosteroid therapy consecutive to hemodialysis and charcoal hemoperfusion may be useful for AKI induced by delayed MTX elimination even in the elderly.

This clinical case presents a patient with NSCLC who experienced on-target resistant mutations and tumor cell transformation from adenocarcinoma to large cell neuroendocrine and small cell carcinoma. Our patient was successfully treated with a combination of targeted therapy, immunotherapy and chemotherapy based on genetic and histologic changes that occurred in a period of five years.

Introduction

Imatinib has led to a phenomenal progress in the treatment of GIST. A rare and lesser-known side effect of imatinib is pneumonitis, an uncommon multicausal interstitial lung disease.

Methods

Patients registered within the Dutch GIST Registry (DGR) were reviewed. For the patients identified with an imatinib-induced pneumonitis we reported the time on imatinib to develop pneumonitis, how the pneumonitis was diagnosed, graded and managed, and how the GIST treatment was managed.

Cases

Of the 1934 patients registered in the DGR, 1161 patients received imatinib at some point, of which nine patients (0.8 %) were identified with an imatinib-induced pneumonitis. At time of the pneumonitis, patients received a daily imatinib dose of 200–400 mg for a mean duration of 486 days. One patient was able to continue imatinib in a lower dose, in the other eight patients imatinib was interrupted, and six of these patients started prednisolone treatment. After management of the imatinib-induced pneumonitis, four patients stopped imatinib permanently, two patients were rechallenged with imatinib, and two patients started treatment with second-line sunitinib.

Conclusion

Imatinib-induced pneumonitis is a rare side effect, which may affect GIST management considerably. After the management of imatinib-induced pneumonitis, clinicians are left with difficult treatment dilemmas.

Renal angiosarcomas are rare malignancies with approximately 70 published cases and comprise less than 1 % of all kidney tumors. We present an elderly male who was found to have a large 10 cm kidney mass and underwent a left radical nephrectomy. Pathology revealed a renal angiosarcoma and unfortunately 3 months later was found to have metastatic disease in the liver. He was incidentally found to have a JAK2 positive myeloproliferative neoplasm at the same time. Molecular testing on the angiosarcoma revealed a JAK2V617F mutation. He was treated with standard of care chemotherapy; initially with paclitaxel and then anthracyclines. He also received liverdirected therapy with Y90 with stable disease. He unfortunately passed away due to an unrelated illness. Our case highlights a rare type of kidney malignancy and that JAK2V617F is a potential driver mutation in angiosarcomas.