Thymic carcinoma is an uncommon malignant neoplasm arising from the epithelial cells of the thymus. Despite aggressive local treatment, patients with thymic carcinoma tend to relapse at distant sites; including: regional lymph nodes, bone, liver and lung. Brain metastases are seldom seen in cases of thymic malignancies. Herein we report a case of thymic carcinoma complicated by brain metastases.
The molecular profile of radiation-induced cancers remains poorly understood. This case report describes a 59-year-old male never smoker with a distant history of Hodgkin's lymphoma treated with mantle radiation who decades later develops primary lung adenocarcinoma within the prior radiation portal. Genomic profiling of the cancer demonstrated a KRAS G12V mutation. We briefly review the clinical entity of radiation-induced second malignancies and KRAS mutant lung adenocarcinoma. Although to date there is no standard molecularly targeted therapy available for KRAS mutant lung cancer, prior reports of activating EGFR mutations in a proportion of radiation-induced lung cancers suggest that a variety of genomic alterations may occur in these secondary malignancies. Given the potential to identify other molecularly defined subsets of lung cancer for which specific therapies exist, routine molecular profiling of these cases seems reasonable.
A case of a collision carcinoma–carcinoid tumor of the rectum that arose in ulcerative colitis (UC). The patient was a 78-year-old man with a rectal tumor, who was diagnosed as having UC at 70 years of age. The tumor was diagnosed by endoscopy as a deep submucosal invasive rectal carcinoma. The patient underwent trans-anal local excision. Pathological examination of Hematoxylin–Eosin stained slides showed two different histological types: a conventional well differentiated tubular adenocarcinoma with submucosal invasion, and another that was composed of small cells with uniform nuclei and eosinophilic granular cytoplasm arranged in a trabecular pattern. Immnohistochemically, these cells were positive for chromogranin A and CD56. These cells exhibited a Ki-67 index that was less than 2% and mitosis in less than 1/10 HPF. These areas showed clear margins. Therefore, this tumor was considered to be a collision carcinoma–carcinoid tumor. Ultimately, the patient died 2 years after the local excision due to recurrence. Collision carcinoma–carcinoid tumors arising in ulcerative colitis are extremely rare. Collectively, it is considered that the behavior of the collision tumor is relatively aggressive. More careful surveillance of colorectal collision or composite carcinoma–carcinoid tumors is necessary, even when the carcinoma is early stage or the carcinoid is small.
Enhanced glycolysis is observed during tumorigenesis, with an upregulation in key glycolytic enzymes. Hexokinase II (HKII) catalyzes the first irreversible step of glycolysis and is often overexpressed in tumors. Abnormal vasculature within tumors leads to regional ischemic conditions that promote tumor progression. The aims of this study were to assess the expression of HKII in colorectal cancer tissues, and to correlate HKII expression with clinical parameters and patient outcome.
Sections from 60 FFPE primary colorectal cancer tumor samples were dual fluorescence immunostained for HKII and carbonic anhydrase IX (CAIX; serving as an ischemic marker) and assessed using semi-quantitative immunofluorescence. Associations of HKII and CAIX levels with patient characteristics, tumor pathology and clinical outcome were studied using univariate analysis.
HKII expression was found in neoplastic cells of non-ischemic regions of tumors and within the tumor stroma. CAIX expression was found primarily in neoplastic cells, and was associated with patient age (OR=4.04, ≥70 vs. <70). Tumor samples scoring lower for HKII were associated with early disease progression (p=0.0155) and poor overall survival (p=0.0248). Interestingly, tumor samples that presented with stromal HKII staining were associated with early disease progression (p=0.0485) and poor overall survival (p=0.0235).
We identified low overall HKII expression to be associated with the outcome of colon cancer. However, the correlation between stromal HKII expression and worse survival in colorectal cancer patients warrant further investigation.
This study assessed the prognostic value of hexokinase II expression in colorectal cancer. In total, 60 FFPE primary colorectal cancer tumor samples were immunostained and correlated with patient characteristics, tumor pathology and clinical outcome. Interestingly, low overall HKII expression was correlated with worse patient outcome. Separately, stromal HKII staining was correlated with worse patient outcome.
Breast metastasis of malignant tumors is very rare. The most common malignant tumor in this organ is of primary ductal origin.
The most common site of metastasis in colorectal adenocarcinoma is liver. Metastasis of colorectal cancer to the breast parenchyma is an extremely rare event. Since 25 years ago, 22 cases of colorectal metastasis to the breast, presenting as breast mass have been reported in the English literature.
In this case report, we will describe our experience with a young lady presenting with a breast mass 10 years after the diagnosis of colorectal cancer. Less than a year after excision of the breast mass (lumpectomy), the breast metastasis became so extensive that palliative mastectomy was the only palliative surgery to be performed for her.
To the best of our knowledge our patient is the youngest case of breast metastasis from colorectal adenocarcinoma developing 10 years after surgery (the longest interval reported so far).
Solid pseudopapillary tumors of the pancreas are rare neoplasms of low malignant potential that affect mostly young women. With a free-margin surgical resection, the prognosis is usually excellent; however, in some cases, curative surgery cannot be performed due to the extent of the tumor mass and metastatic spread. Optimal therapeutic option in such cases remains elusive.
We analyze a case of a 36-year-old female patient treated with chemotherapy due to advanced stage of solid pseudopapillary tumors. Among a number of administered chemotherapeutic regimens – Folfox-4 (folinic acid+fluorouracil+oxaliplatin) gave particularly good results and was well tolerated, with few adverse effects. Partial response was achieved and significant improvement in the patient's life quality was reported.
Solid pseudopapillary tumors of the pancreas present slow growth pattern and an excellent prognosis in most cases. Different approaches are needed for patients with multiple, unresectable metastases and oxaliplatin based chemotherapy should be considered as effective and safe therapeutic option.
The absence of proper guidelines for unresectable SPTs and second-line chemotherapy for gemcitabine-refractory patients with metastatic pancreatic pseudopapillary tumors emphasizes the importance of seizing new therapeutic options.
Invasive ductal carcinoma with predominant intraductal component (DCIS-IDC) has a favorable survival outcome. However, whether subtypes of DCIS-IDC have prognostic significance remains unknown. We assessed the prognostic value of immunohistochemical subtypes in DCIS-IDC compared with DCIS or IDC without predominant intraductal component.
We retrospectively studied 37,049 early breast cancer patients enrolled in the Korean Breast Cancer Registry between January 1993 and February 2011. We categorized DCIS, DCIS-IDC and IDC by estrogen receptor, progesterone receptor, and human epidermal growth factor receptor 2 (HER2) expressions, such as luminal A, B, HER2 and Triple negative breast cancer(TNBC). Multivariate Cox regression analysis was used to estimate associations between subtypes and survival.
In total, 8346 patients (26.3%) had DCIS, 20,427 (64.4%) had IDC and 2938 (9.3%) had DCIS-IDC. Luminal A type was the most predominant type in all three groups (DCIS=66.5%, IDC=64.7%, DCIS-IDC=46.9%). HER2 subtype was more frequent in DCIS-IDC (27.0%) than in IDC (8.3%) and DCIS (13.3%) (p<0.001). TNBC subtype was more frequent in IDC (18.0%) than in DCIS (8.5%) and DCIS-IDC (12.7%) (p<0.001). Breast cancer subtypes showed significant differences in breast cancer specific survival in IDC. HER2/neu typed DCIS showed a poor prognostic effect in overall survival, but no differences were observed in DCIS-IDC before or after adjusted by adjuvant treatments.
Different distribution of subtypes and indistinct prognostic effects in DCIS-IDC indicates that DCIS-IDC is a distinct clinical and biological entity from pure IDC or pure DCIS.
Through a large-sized, registery-based study, we reported differences of IHC-breast cancer subtypes or outcomes in pure IDC, pure DCIS and mixed DCIS-IDC cases with a predominant DCIS component (more than 80% of tumor was DCIS). IHC-breast cancer subtypes of invasive ductal carcinoma with predominant intraductal component were not significant prognostic factor unlike either pure IDC or DCIS.
We subdivide breast cancer into pure IDC (64%), pure DCIS (26%) and mixed DCIS-IDC cases (9%) with a predominant DCIS component (more than 80% of tumor was DCIS). Within IDC, they observed differences in outcome that correlated with phenotype, among approximately 37,000 cases entered into the Korean cancer registry.
They did not observe statistical differences in outcome with phenotypes for the DCIS-IDC group.
This study supports that there is a biologic difference between DCIS-IDC cases compared to pure DCIS or pure IDC.
Fine needle aspiration cytology continues to be the first line modality for definitive diagnosis of palpable and non palpable breast masses. Despite its high accuracy, some cases may pose a diagnostic dilemma. We present a case of a 42 year old female who was clinico-radiologically and cytologically mislabelled as plasmacytoma but was subsequently diagnosed as poorly differentiated carcinoma breast on histopathology and immunohistochemistry. Aspiration cytology is a minimally invasive procedure with rapid turn around time but in cases with unusual cytological picture, a core biopsy along with immunohistochemistry must accompany cytology to maximize the preoperative diagnosis of malignant breast lesions in order to ensure appropriate management.
Brain metastases are common in non-small cell lung cancer (NSCLC) and traditionally have been treated with whole brain radiation therapy, surgery, or stereotactic radiosurgery, with a limited role for systemic therapy. However, the development of highly active small molecule tyrosine kinase inhibitors for patients with NSCLC characterized by key driver mutations has generated interest in the use of systemic therapy as an alternative to potentially morbid local therapy for brain metastases. We present the case of a 59 year old Caucasian female with anaplastic lymphoma kinase (ALK) rearranged NSCLC who developed a large symptomatic brain metastasis not initially amenable to stereotactic radiosurgery (SRS) while receiving the ALK inhibitor crizotinib. The lesion regressed quickly after initiation of ceritinib, a next generation ALK inhibitor with known activity against crizotinib refractory ALK rearranged NSCLC, thereby allowing SRS as an alternative to standard craniotomy and consolidative whole brain radiation therapy.
This study was designed to evaluate the feasibility of concurrent induction chemoradiotherapy (CRT) using S-1, an oral fluoropyrimidine derivative, plus cisplatin followed by surgery in locally advanced non-small cell lung cancer (NSCLC).
We defined locally advanced NSCLC as pathologically proven chest wall invasion or hilar and/or mediastinal lymph node metastases by endobronchial ultrasound-guided transbronchial needle aspiration. Twenty-three patients were enrolled in this study from May 2011 to April 2014. The patients received S-1 40 mg/m2 orally twice daily on days 1 through 14 and 29 through 42, and cisplatin 60 mg/m2 was injected intravenously on days 8 and 36. The patients also underwent radiotherapy and received a total dose of 40 Gy in 20 fractions beginning on day 1. Surgical resection was performed from 4 to 6 weeks after completion of the induction treatment.
Of the 23 eligible patients, 18 had stage IIIA and 5 had stage IIB NSCLC. Twenty patients (87.0%) completed induction CRT and underwent surgical resection. Representative grade 3 adverse reactions were neutropenia (21.7%) and leukocytopenia (8.7%); no grade 4 adverse reactions were observed. Radiologically, 7 (30.4%) of the 23 patients achieved partial response and were therefore radiologically downstaged. Twenty patients were curatively resected. Six (26.1%) complete responses were identified and 12 cases (52.2%) were histopathologically downstaged by induction CRT.
Concurrent induction CRT using S-1 plus cisplatin is a feasible and promising new treatment modality for locally advanced NSCLC. Evaluation of histopathological downstaging revealed sufficient anti-cancer effects for preoperative treatment.
Because chemoradiotherapy (CRT) using cisplatin and S-1, an oral fluoropyrimidine, is effective for unresectable non-small cell lung cancer, the feasibility of this therapy in a neoadjuvant setting was evaluated in a multicenter phase II study. Toxicities were very mild and 87.0% of the 23 patients completed induction CRT. This protocol seems feasible and is considered an option among preoperative therapies.
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