Current problems in cancer. Case reports最新文献

Interferons are widely expressed cytokines that possess potent anti-viral and anti-tumor activity. As therapeutic agents, interferons have proven useful in treating assorted cancers, chronic infections, and autoimmune disease. However, interferon therapy has well-known adverse effects, including flu-like symptoms, depression, triggering of autoimmune phenomena, and dose-dependent cytopenias. In this report, we describe two cases of congestive heart failure occurring after treatment with interferon-gamma (a type II interferon) for advanced cutaneous T cell lymphoma. Based on existing mechanistic studies, both the potentiation of autoimmunity and the direct cytotoxic effects of interferons on the myocardium may account for this uncommon adverse effect of interferon therapy.

Paraneoplastic neurological syndrome (PNS) is rarely associated with malignant pleural mesothelioma (MPM). We report the first case of sarcomatoid mesothelioma in a 63-year-old female diagnosed with cerebellar degeneration in January 2018. Systemic examination showed right pleura thickening. The pleural biopsy of the mass revealed a sarcomatoid MPM cT3N0M0. In February 2018, anti-Ma2 antibody positivity indicated PNS complicated with MPM. First, cisplatin (75 mg/m²) + pemetrexed (500 mg/m²) chemotherapy was given. For PNS, steroid pulse therapy and high-dose immunoglobulin therapy were administered. MPM may cause anti-Ma2 antibody-related PNS. Early diagnosis and starting anticancer treatment and immunotherapy are critical.

CA 19-9 (carbohydrate antigen 19-9) is used as a biomarker for hepatobiliary cancer and is generally not considered helpful in the evaluation of gynecologic cancer. Endometriosis-associated cancers are a subset of gynecologic cancers in which malignancy is found adjacent to endometriosis either within or outside the gynecologic tract. We describe a case of a woman who presented with a CA 19-9 level of 49,469 U/mL who was subsequently found to have two concurrent but separate primary endometriosis-associated cancers involving the ovary and small intestine. Although data regarding the association between CA 19-9 and endometriosis-associated malignancy is lacking, endometriosis is known to be associated with high levels of inflammation which in turn has been associated with higher CA 19-9 levels. The inflammatory response and effect on CA 19-9 levels may be particularly pronounced in cases where endometriosis-associated malignancy involves the peritoneum. The case described suggests that when cancer is suspected in a woman with an extremely high level of CA 19-9 and no apparent hepatobiliary disease, an endometriosis-associated malignancy may be a consideration.

Large cell neuroendocrine carcinoma of the lung is a rare and aggressive pulmonary malignancy. Given its peripheral location, patients are frequently asymptomatic at the time of diagnosis or present with non-specific complaints. Moreover, its association with paraneoplastic syndromes or structural intrathoracic complications are highly atypical. Here, we report a case involving a 57-year-old female who presented with two simultaneous paraneoplastic syndromes, including hypertrophic pulmonary osteoarthropathy and secretory diarrhea, prior to the diagnosis of an early-stage large cell neuroendocrine carcinoma of the lung. Both syndromes showcased rapid symptomatic resolution following tumor resection. Upon disease recurrence, the patient developed a presentation consistent with Pancoast syndrome, with gradual improvement following the initiation of chemoradiotherapy. Individually, these conditions are rarely reported in association with large cell neuroendocrine carcinoma of the lung making their combination highly unusual. Furthermore, related symptoms were present both before and at the time of diagnosis, and upon disease recurrence. This highlights the importance of maintaining a high clinical suspicion for atypical manifestations of malignancy.

Pulmonary tumor thrombotic microangiopathy (PTTM) is a paraneoplastic syndrome associated with mucin secreting adenocarcinomas, usually gastric. Mucin secretion releases the coagulation cascade and activates endothelial growth factors, causing thrombosis and endothelial proliferation with secondary luminal stenosis. PTTM, which is usually fatal in a very short time, presents a significant ante-mortem diagnostic challenge. We report the case of a 59-year-old woman with metastatic pancreatic adenocarcinoma who developed PTTM, leading to cor pulmonale and lethal cardiogenic shock. This is the fourth case report of PTTM secondary to pancreatic adenocarcinoma. The clinical suspicion was confirmed in the autopsy when a second, previously undetected tumor was found. This report highlights the need for postmortem studies in current oncology practice.

Undifferentiated round cell sarcomas (URCS) are an extremely rare form of cancer, comprising a heterogeneous group of bone and soft tissue tumors occurring primarily in young adults (but distributed across all ages; range 2mo-81 years) and displaying a slight male predominance. URCS are primarily identified by their genetic abnormalities, with three recurrent oncogenic fusion rearrangements associated in the literature and recently added to the WHO classifications: EWSR1-non-ETS, BCOR-CCNB3, and CIC-DUX4. We present/describe a rare case of an URCS diagnosed in a 27-year-old female following six years of non-specific symptoms including pain and swelling of the third proximal phalanx. This case is only the third reported in a digit and, based on FoundationOne genotyping, was uniquely treated with tamoxifen. This patient also received radiation therapy, surgical resection, and palliative chemotherapy. Metastases were noted in the lungs and mediastinum, and the patient died of disease 89 months after the first treatment. While diagnosis of these tumors is becoming increasingly dependent on molecular profiles, treatment remains mostly unchanged and does not largely reflect the use of genetic results in treatment plans. A comprehensive review of the literature was completed to examine URCS and assist in the development of a diagnostic/treatment algorithm.

Since the FLAURA trial, epidermal growth factor receptor (EGFR) mutation-positive non-small cell lung cancer (NSCLC) has generally been treated with osimertinib as a first-line therapy. However, there is still insufficient data on the therapeutic efficacy of EGFR-tyrosine kinase inhibitors in NSCLC patients with uncommon mutations. Many of these minor mutations are resistant to osimertinib; one such mutation is EGFR L718V or L718Q (L718V/Q), which may occur in combination with L858R. L718V/Q has been identified as a resistance gene to osimertinib when progressive disease occurs during treatment with osimertinib. Some reports have shown that EGFR L718V/Q with L858R is resistant to osimertinib but sensitive to afatinib. All cases of L718V/Q mutation-positive NSCLC reported in previous studies have presented with L718V/Q as the acquisition of resistance after treatment with osimertinib. In the present case report, we describe a rare case of NSCLC with de novo EGFR L718V and L858R mutations. Consistent with previous reports, the patient was resistant to osimertinib but responded well to afatinib.