Current problems in cancer. Case reports最新文献

英文中文

Revisiting the Whipple procedure in chondrosarcoma metastasis to the pancreas 再次探讨胰腺软骨肉瘤转移的惠普尔手术

IF 0.2 Q4 ONCOLOGY

Current problems in cancer. Case reports

Pub Date : 2024-11-16 DOI: 10.1016/j.cpccr.2024.100333

Joseph S Lim , Daniel Zeter , Paul Murdock , Joseph Saad , Houssam Osman , Joseph Buell , Dhiresh Rohan Jeyarajah

Introduction

Chondrosarcoma is the second most common primary bone cancer with the lungs being the primary site of metastasis. Pancreatic metastases can occur, but their rarity makes management challenging.

Presentation of case

A 27-year-old female with a past medical history of childhood chondrosarcoma of her left tibia presented with metastatic chondrosarcoma of the pancreas five years later. The patient underwent an upfront Whipple procedure with positive margins. Upon recovery, her oncology team recommended watchful waiting. One year later, she presented to the emergency department with coffee ground emesis and diffuse abdominal pain. A computed tomography scan showed a large recurrent mass at the pancreatic remnant concerning for local recurrence. Upper endoscopy found active bleeding near the gastrojejunostomy anastomosis with no ulcers as well as portal hypertensive gastropathy. After discussing these findings, the patient ultimately declined any further treatment, and she was discharged to hospice.

Discussion

This is the second reported case of a Whipple procedure for metastatic chondrosarcoma, and first with positive margins (R1). It appears that chondrosarcoma metastasis to the pancreas requiring Whipple procedure is associated with poor outcomes. This unfortunate result is further compounded by the lack of neoadjuvant or adjuvant chemotherapy or radiation in the setting of R1 resection.

Conclusion

Upfront Whipple procedure in metastatic chondrosarcoma at high risk for R1 resection should be considered with neoadjuvant radiation Adjuvant radiation can be considered if there are positive margins.

软骨肉瘤是第二常见的原发性骨癌，肺是主要的转移部位。胰腺转移可能发生，但其罕见性使得治疗具有挑战性。病例介绍一位27岁女性，既往有左胫骨软骨肉瘤病史，5年后出现胰腺转移性软骨肉瘤。患者接受了前期惠普尔手术，切缘呈阳性。康复后，她的肿瘤团队建议她耐心等待。一年后，她以咖啡渣呕吐和弥漫性腹痛就诊于急诊科。计算机断层扫描显示胰腺残肢处有一个大的复发肿块，可能是局部复发。上镜检查发现胃空肠吻合口附近活动性出血，无溃疡及门脉高压性胃病。在讨论了这些发现后，患者最终拒绝了任何进一步的治疗，并出院到临终关怀医院。这是报道的第二例转移性软骨肉瘤的惠普尔手术，第一例阳性切缘（R1）。软骨肉瘤转移到胰腺需要惠普尔手术似乎与不良预后相关。由于在R1切除时缺乏新辅助或辅助化疗或放疗，这一不幸的结果进一步加剧。结论对于转移性软骨肉瘤R1切除高危患者，应考虑行Whipple手术，并配合新辅助放疗。

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引用次数: 0

Atypical presentation of lung adenocarcinoma as cardiac tamponade and venous thromboembolism: A case report 肺腺癌的不典型表现为心脏填塞和静脉血栓栓塞1例

IF 0.2 Q4 ONCOLOGY

Current problems in cancer. Case reports

Pub Date : 2024-11-13 DOI: 10.1016/j.cpccr.2024.100331

Amit Kumar, Sandeep Garg, Praveen Bharti, Manidipa Mondal

引用次数: 0

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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