Current problems in cancer. Case reports最新文献

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.

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.

Breast cancer (BC) is a complex and heterogeneous disease including different biological subtypes. This results in molecular and phenotypic heterogeneity within the BC. Stratification of tumors contributed to achieving better outcome in terms of response to therapy and overall survival. Little is known about the features of clonal heterogeneity in different lesion in BC patient. We reported a case of a 52-year-old woman who was diagnosed with luminal B (HER2−) BC and accepted chemotherapy. She achieved partial response based on RECIST 1.1 criteria. However, progressive disease (PD) was then identified with multiple subtypes including luminal B and triple-negative breast cancer (TNBC). Next-generation sequencing (NGS) technologies showed that the different regions of diseased tissue were originated from same clonal genes. We also demonstrated the clonal heterogeneity and gene characterization between lesions of luminal B and TNBC. The patient archived complete remission (CR) with a clear beneficial outcome from immunotherapy treatment. In addition, tumour mutational burden (TMB) and DNA damage repair (DDR) pathway were considered as potential biomarkers for better prediction of tumor immunotherapy efficacy.

Airway blockage frequently occurs in advanced lung cancer patients, leading to breathing difficulties and oxygen deprivation. This severely impacts patients' quality of life and can even result in death. Bronchial stent insertion effectively alleviates these symptoms and is often performed with intravenous general anesthesia. Nevertheless, during anesthesia and the procedure, inadequate ventilation can lead to severe oxygen deficiency and subsequent complications. There is an urgent need for a safe and efficient intraoperative ventilation strategy to maintain sufficient oxygen levels and reduce the risk of oxygen deficiency. We present a case of successful bronchial stent placement using high-flow nasal cannula (HFNC) in conjunction with intravenous general anesthesia. The patient, a 64-year-old male with a one-year history of right peripheral lung cancer, sought treatment for persistent cough and breathing difficulties. Chest X-rays upon admission revealed a substantial increase in the size of the anterior segment of the right upper lung lobe, likely due to peripheral lung cancer complicated by obstructive pneumonia. To address the patient's airway compression symptoms, we proposed "bronchoscopic tracheal stent insertion." The patient exhibited an ejection fraction of 45% on cardiac ultrasound, had limited physical activity tolerance, grade III heart function, severe airway constriction, and maintained oxygen saturation (SPO₂) levels between 85% and 88%. We successfully performed the procedure using HFNC in combination with intravenous general anesthesia, resulting in a significant improvement in airway compression symptoms. In this case, it was found that HFNC could be used as a new non-invasive respiratory support therapy for bronchial stent implantation under intravenous general anesthesia to reduce the occurrence of intraoperative hypoxemia.

Background

This case report aims to describe an adverse reaction following intra-arterial melphalan chemotherapy in a 48-year-old female patient with choroidal melanoma. The chemotherapy was part of a phase I clinical trial (MELCOM Study - ClinicalTrials.gov ID: NCT05893654), designed to evaluate its efficacy as a bridge to Ru-106 brachytherapy for treating large uveal melanomas. This is the first reported case of a cutaneous reaction to melphalan in an adult patient.

Observations

Upon administration of melphalan, the patient developed an erythematous periorbital skin lesion three days post-treatment. The lesion evolved into a hyperchromic brownish macule that later disappeared spontaneously.

Conclusions and Importance

While melphalan successfully reduced the tumor dimensions, making the patient eligible for subsequent Ru-106 brachytherapy, it led to a cutaneous reaction previously reported only in pediatric patients. Despite this aesthetic complication, the therapy was effective in tumor reduction, highlighting the need for further studies to assess the risk-benefit profile of intra-arterial melphalan chemotherapy in adult populations.

We report the case of a 48-year-old female with a history of tubal ligation who presented to her PCP with altered mental status and back pain. Inpatient workup revealed multiple myeloma, and treatment with bortezomib and dexamethasone was initiated. Due to teratogenicity on lenalidomide, a pre-treatment urine pregnancy test was performed and returned positive. She denied sexual activity and had no history of germ cell tumor. While urine hCG remained low positive for three tests, her serum hCG remained normal (<5 mIU/mL). The uncertainty in pregnancy testing caused a delay in full-dose induction therapy. With two cycles of bortezomib and dexamethasone, her M-Spike only dropped from 4.8 to 2.9 g/dL. Ultimately urine hCG normalized, and she was started on lenalidomide with cycle number three. With the addition of lenalidomide, after two cycles, her M-Spike disappeared, and bone marrow biopsy showed complete resolution of plasma cell dyscrasia. The phenomenon of positive hCG testing in multiple myeloma is discussed, highlighting the importance of provider and patient awareness in the setting of a non-gravid woman to prevent a disruption of standard of care treatment and patient distress.

Parathyroid carcinoma is one of the rare causes of primary hyperparathyroidism, comprising less than 1 % of its cases. Diagnosing parathyroid carcinoma typically requires a comprehensive evaluation using clinical, histological, and radiological methods. Primary hyperparathyroidism secondary to parathyroid carcinoma often presents with hypercalcemia, bone abnormalities, and renal stones. Brown tumours, a rare and late manifestation of hyperparathyroidism, signify the final stage in bone remodelling, and they can be easily mistaken for bony metastases, which highlights the importance of distinguishing between them to ensure appropriate management and avoid unnecessary treatment. Due to the rarity of parathyroid carcinoma, there is currently no standardized staging system or specific guidelines for its management. Consequently, the involvement of a multidisciplinary team has become crucial in addressing this disease. Surgery is considered the primary treatment approach, while the role of adjuvant radiotherapy and chemotherapy remains controversial. With ongoing research, the treatment landscape for parathyroid carcinoma may evolve, offering new hope for improved outcomes and quality of life for affected individuals.

Thymoma and thymic carcinomas are rare tumors with limited therapeutic options for platinum-refractory cases. Recent studies have shown positive response rates in anti-angiogenic multi-kinase inhibitors (MKI) such as lenvatinib and sunitinib and immune checkpoint inhibitors including pembrolizumab, though they have yet to be tested in combination. Here, we present a case of a patient with heavily pre-treated PD-L1 negative metastatic thymic carcinoma and no targetable mutations treated with combination lenvatinib and pembrolizumab following initial response then progression from lenvatinib monotherapy. He had a partial response with decreased tumor burden in the liver with lenvatinib monotherapy and then in the lungs with combination therapy. Treatment was continued and he continues have clinical benefit with stable disease at 9 months with minimal toxicities. This case is one of the first reported clinical evidence for MKI and immunotherapy in combination as a promising second-line approach for thymic carcinomas.

Low-grade adenosquamous carcinoma (LGASC) is a rare variant of metaplastic breast carcinoma that consists of glandular and squamous elements in a spindle cell background. They lack distinctive imaging features and overlap with other breast neoplasm characteristics, posing a diagnostic challenge. We present the case of a 60-year-old woman with metachronous bilateral invasive breast carcinoma (MBBC). The mastectomy specimens of her left breast carcinoma revealed nests of squamous- appearing cells and “comma” glandular structures on a microscopic level. Comprehensive immunohistochemical examination of ER, PR, Her-2, p63, and CK7 CK5/6 confirmed the diagnosis of LGASC. Unlike other invasive breast carcinomas, LGASC have an indolent course and favorable prognosis. Eight years after surgery, she was diagnosed with a non-specific type of invasive breast carcinoma of the right breast via imaging, core needle biopsy and immunohistochemistry. This was a rare case of MBBC that has not been previously reported. Therefore, we report and review the relevant literature to raise awareness of this disease.