Cancer treatment communications最新文献

We herein report a case of primary pulmonary hepatoid adenocarcinoma in a 71 year old man and provide an overview on knowledge and existing reports of this rare tumour. Primary pulmonary hepatoid adenocarcinoma is an AFP-producing lung tumour composed of neoplastic cells morphologically resembling hepatocellular carcinoma. The main challenge for physicians encountering such tumours is distinguishing between hepatocellular carcinomas and pulmonary hepatoid adenocarcinomas. Previous literature is conflicting, particularly around the distinguishing immunohistochemical characteristics of the two tumours. Given the rarity of this tumour and paucity of published literature, we believe the clinical–radiological characteristics provide the key to diagnosis and aim to demonstrate this in our case.

Oxaliplatin is a third generation platinum compound, which is usually used in combination with capecitabine or 5 fluorouracil for gastro-intestinal cancers. With Oxaliplatin based chemotherapy, the common adverse effects include neurological, hematological and gastrointestinal toxicities. Less common side effects includes dermatological, hepatic and pulmonary toxicities. Interstitial lung disease and pulmonary fibrosis were reported with Oxaliplatin based combination chemotherapy, but was not noticed when single agent Oxaliplatin was used. Here we report, a case of single agent Oxaliplatin induced interstitial lung disease.

Aims

Optimal management of Pleomorphic lobular carcinoma-in-situ (PLCIS) remains a matter of debate. We aimed to identify presenting clinical, radiological and histopathological features and oncological outcome of PLCIS.

Methods

From a prospectively maintained histopathology database between January 2000 and June 2014, all patients with a diagnosis of PLCIS were identified, and retrospective review of case notes performed.

Results

Of 19 cases, only 3 presented as symptomatic lumps, however 11 had mass lesions on imaging. All patients underwent definitive cancer surgery with wide margins. In all but three cases, PLCIS was associated with additional pathologies (DCIS, ILC, IDC), highlighting the pluripotential development of breast cancer. Of the six cases with no invasion, three were oestrogen receptor negative. There were no local or systemic recurrences over the median follow up period of 66 months.

Conclusion

PLCIS presenting without invasion is rare and, unlike invasive cancer and ductal carcinoma-in-situ, does not appear to be predominantly associated with ER positivity. However, PLCIS is almost universally associated with invasive cancer or DCIS, and should be managed with wide excision and clear margins.

Clinical practise points

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  There is uncertainty surrounding the management of PLCIS as highlighted by the lack of guidelines on this unusual disease entity.

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  The commonest presentation of PLCIS is in asymptomatic women through breast screening.

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  PLCIS presenting without invasion is rare and unlike invasive breast cancer and DCIS, does not appear to be predominantly commonly associated with ER positivity.

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  PLCIS is commonly associated with in-situ and invasive lesions, with 58% of cases associated with invasive lobular carcinoma in this current series.

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  Breast conserving surgery with clear margins and adjuvant treatment as dictated by associated pathology and molecular profile is recommended for PLCIS.

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  In patients presenting with a mass lesion, and pure PLCIS on diagnostic core biopsy: A re-biopsy, ideally using vacuum-assistance is recommended, to attempt to upgrade the tumour pre-operatively, as invasion is almost universal in this subset.

Anal carcinoma is relatively uncommon cancer in the United States and comprises only 2.1% of all gastrointestinal malignancies with the estimated incidence rate of 1.8 per 100,000 per year. The current report describes a case of ACA diagnosed in a 75 years old male with emphasis on overall management of ACA. A 75 years old male with history of hemorrhoids presented to his primary care provider with complaints of anal irritation and occasional bleeding per rectum. On physical examination a large fungating mass protruding from anal verge was seen. Colonoscopy demonstrated rectal polyps in superior, middle and inferior rectal area and the lesion at the anal verge. Biopsy of perianal tissue and posterior anus revealed invasive mucinous adenocarcinoma. Patient's cancer was defined as Stage IIIB (T2, N3, M0). Chemotherapy with capecitabine and radiation therapy was started. After 2 months capecitabine was discontinued as patient developed side effects that included-weakness, diarrhea, nausea and vomiting. 8 months later patient underwent abdominoperitoneal proctosigmoidectomy with creation of permanent colostomy as tumor mass did not regress. A repeat PET scan showed recurrence of tumor in inguinal lymph nodes, biopsy confirmed necrotic metastatic tumor. After a year patient was diagnosed with acute myocardial infarction and went to hospice care. Research into anal adenocarcinoma is limited by the rarity of the condition. Most studies contain a small number of patients accumulated over a long period of time, resulting in heterogeneous study populations with widely variable approaches to management.

Micro abstract

This study assessed physical performance and health-related quality of life one year after lung cancer surgery and investigated the potential association between both outcomes. We found that the walked distance was associated with the subjective perception of the physical functioning. Patients improved health-related quality of life, reaching values similar to a healthy reference population.

Background

Resuming an acceptable level of lifestyle and health-related quality of life after lung cancer surgery has become an important issue. We aimed to evaluate the course of recovery of physical performance and health-related quality of life following pulmonary resection for lung cancer, as well as examine the potential association between these outcomes.

Methods

In an observational design, we assessed 78 individuals radically operated for lung cancer. We measured health-related quality of life (SF-36), six-minute walk test (6MWT) and lung function (spirometry) three weeks (baseline), four and twelve months after surgery. SF-36 values were compared to an age- and gender-matched reference population.

Results

The mean age was 65 years (SD9), 59% were males. Thoracotomy was performed in 77% of the cases. Compared to baseline values, we found significant improvements after one year in SF-36 physical and mental component summary components of large effect size (0.8 and 0.9 respectively). Values for both SF-36 summary components were comparable to those of the reference population. The improvement in 6MWT was of moderate effect size (0.6). We found a positive association between 6MWT and the SF-36 domain for physical functioning (β=0.05, 95% CI [0.00;0.09], p=0.03) one year after surgery.

Conclusion

Individuals who were radically operated for lung cancer improved health-related quality of life one year after surgery, reaching values similar to a healthy reference population. The walked distance was positively associated with the subjective perception of physical functioning. The clinical significance of these findings deserves further investigation.

A 69-year-old woman underwent thoracic computed tomography (CT), which revealed a nodule in the superior segment of the right lower lobe. Transbronchial lung biopsy revealed small cell lung cancer. No metastasis was detected. However, one month later, repeat CT showed spontaneous regression of the tumor. We performed segmentectomy, which confirmed that the tumor was stage IA small cell lung cancer. The patient received adjuvant chemotherapy, with no recurrence for 27 months. Spontaneous regression of small cell lung cancer is very rare. Our treatment strategy may have contributed to a favorable prognosis.

Introduction

The effect of neoadjuvant chemotherapy (NAC) on the expression of receptor status in locally advanced breast cancer (LABC) is still under investigation. Aims of this study are to evaluate changes in hormone receptor (HR) and HER-2 status post-NAC and correlation with survival.

Materials and methods

LABC patients who received NAC between 2001 and 2008 at Istanbul University were analyzed retrospectively. Patients with pathologic complete response (pCR) were excluded in analysis. Immunohistochemical (IHC) analyses was performed on both initial biopsies and surgical specimens.

Results

The median age of 128 patients was 48 years and 55% of them were premenopausal. Most of the patients had invasive ductal (81%) and histologic grade (HG) III (81%) breast cancer. Partial pathologic response (pPR) rate was 86.7%. HR status changed in 36 patients (28%). The rates of ER, PR and HER-2 receptor positivity at diagnosis and after NAC were 44–32.8%, 43–29.7%, and 24–21%, respectively. Negative-to-positive change in HR status was observed in five patients. The 5-year overall survival (OS) was 76% in patients whose HR status converted to negative, compared with 91% in patients who remained HR-positive (p<0.05). Multivariate Cox regression analysis showed that receptor status change was independently related to disease-free survival (DFS) (Hazard Ratio 6.88; p=0.002), whereas as it did not have any impact on OS (p=0.148).

Conclusion

NAC induced changes in HR and HER-2 expression, predominantly from positive to negative. These changes were associated with shorter DFS. Postoperative re-evaluation of receptor status may have clinical significance.

Adenoid cystic carcinoma (ACC) is one of the most common salivary gland malignancy. Loco regional and distant metastases are common in 40–60%, even after a short disease free interval. Most frequently, ACC metastasize to the lung, bone, liver and cerebrum with solid pattern. We present a case of bilateral lung metastases in a patient with ACC and active tuberculosis mimicking bronchoalveolar carcinoma ground glass opacities.

Micro-abstract

Brain metastases are a frequent finding in patients with advanced non-small cell lung cancer (NSCLC). The characteristics of 118 patients with synchronous brain metastases (BM) out of a cohort of 678 individuals with advanced NSCLC (17%) are reported, with synchronous BM having a negative impact on survival. Prognostic factors for survival of the patients with and without BM are presented.

Background

Brain metastases occur frequently in patients with newly diagnosed non-small cell lung cancer. We aim to describe the characteristics, treatment and course of disease in patients with synchronous BM in an advanced NSCLC cohort, and to comparatively analyze prognostic factors for patients with and without BM.

Patients and methods

Of 678 consecutive unselected patients with stage IV NSCLC, 118 presented with synchronous BM (17%; 95% confidence interval [CI]: 15–20%). The patient characteristics, prognostic factors, therapeutic approach and use of specific therapeutic measures including systemic treatment were analyzed.

Results

BM were found more frequently in younger patients, females, non-smokers and those with a lower thoracic stage. 29% of patients with BM exhibited neurologic symptoms. Patients with BM showed worse overall survival (median survival 8.0 vs 9.7 months; HR 1.24 [1.05–1.54]; p=0.045). In multivariable analysis poor performance status at diagnosis showed the strongest negative association with survival.

Conclusion

Synchronous BM are frequent among patients with NSCLC even in early thoracic stages and negatively impact survival. Based on the findings presented in this paper, a therapy algorithm for treating BM is proposed, with systemic therapy being one valuable option.

Small cell lung carcinoma (SCLC) accounts for 15–20% of all lung cancers and is the most aggressive lung-cancer subtype. Even with treatment median overall survival is short, in the range of 9–12 months. Tobacco smoking is the main risk factor with nearly 95% of the cases being linked to smoking. Historically SCLC was classified into two stages – limited stage, when disease is confined to one hemithorax that can be encompassed into one radical radiation field, and extensive stage beyond the former boundaries. Recently, the International Association of the Study of Lung Cancer has proposed using the TNM staging system for more accurate estimation of prognosis. Chemotherapy remains the cornerstone of SCLC management in both limited and extensive stages, in conjunction with radiotherapy. In this case report we are describing a SCLC patient with an unusual pattern of local recurrence and prolonged course of disease.