Cancer treatment communications最新文献

We report the case of a patient with lymphohistiocytoid mesothelioma (LHM) with a response to systemic chemotherapy consisting of cisplatin and pemetrexed. A 72-year-old man was referred to our hospital because of abnormal shadows seen on chest X-rays. He had been exposed to asbestos at shipyards for 3 years. Computed tomography (CT) images of the chest showed multiple masses on the parietal pleura, diaphragm, and the interlobar pleura of the right. CT-guided percutaneous needle biopsy was performed and the biopsy specimen demonstrated fibrous thickening of the pleura with abundant lymphocyte infiltration. Immunohistochemical analyses revealed that the cells were positive for calretinin, WT-1, and CAM5.2, and negative for CEA, TTF-1, CK5/6, AE1/AE3, desmin, CD3, CD20, CD30, and CD68. Based on these findings, the diagnosis was confirmed as LHM. Systemic chemotherapy consisting of cisplatin (75 mg/m²) and pemetrexed (500 mg/m²) was delivered. After 6 courses of chemotherapy, multiple tumors had remarkably regressed, and the patient remains on maintenance treatment with pemetrexed. There are few reports of chemotherapy for LHM. The combination of cisplatin and pemetrexed could be a good treatment option for LHM.

Here we report the case of an ALK-positive NSCLC patient with pathological complete response within 6 months of treatment with crizotinib. This remission was further documented by PET-CT scans until 25 months after initial start of treatment where new brain lesions were detected on MRI. At this time, the patient received local treatment and then alectinib with partial response of the brain metastases and ongoing status of no systematic disease in the PET scans. This case emphasizes the relevance of brain MRI in the follow-up of patients with ALK-translocated adenocarcinoma of the lung, the long-term response to crizotinib and the possibility of CNS disease control with alectinib.

Adenosquamous carcinoma of the lung is an uncommon histological variant of non-small cell lung carcinoma (NSCLC) associated with a poorer prognosis than either adenocarcinoma or squamous cell carcinoma (SCC) histological subtypes. Most adenosquamous carcinomas of the lung present with advanced disease, often with the central nervous system as a common site of metastasis. We present a case of a patient with recurrent adenosquamous carcinoma who presents with multiple cerebral metastases, with two metastatic sites composed of separate distinct histological subtypes, one adenocarcinoma and one SCC. Interestingly, both metastatic deposits were also found to harbor an L858R epithelial growth factor receptor (EGFR) point mutation in exon 21. Upon progression after craniotomy and whole brain radiotherapy, the patient achieved a radiological response with the EGFR inhibitor, erlotinib.

A 39-year-old woman presented with abdominal pain 6 years after her diagnosis of HER2 positive breast cancer. Imaging revealed an enlarged appendix likely representing acute appendicitis. Surgery was performed, and pathological analysis of the appendix indicated metastatic carcinoma. On reviewing the literature, we found a few reported cases of appendicitis caused by metastatic carcinoma of the breast. The possibility of metastasis to the appendix must be considered in the diagnosis of right lower quadrant pain in patients with breast cancer.

Advanced non-small cell lung cancer (NSCLC), the most lethal malignancy worldwide, obtains a small long-term benefit from chemotherapy. However, 16% of Caucasian patients presenting sensitizing mutations in the epidermal growth factor receptor have a high sensitivity to the tyrosine kinase inhibitor gefitinib. Gefitinib is a safe drug, with mild diarrhea, emesis, or skin rash the most common toxicities. However, rare adverse events such as pneumatosis intestinalis have been communicated. We first report a very rare case of emphysematous cystitis in a female patient with EGFR-mutant lung adenocarcinoma while on gefitinib treatment, taken advance to review risk factors for this infectious complication.

Introduction

A rather rare hypersensitivity reaction, periarticular thenar erythema with onycholysis (PATEO) syndrome, has been associated with the taxane class. To date, only docetaxel and paclitaxel have been associated with PATEO. This current case is highly suggestive of an association of nab-paclitaxel with PATEO.

Presentation of case

A 48 year-old female receiving first-line systemic therapy using nanoparticle albumin-bound paclitaxel (nab-Paclitaxel) for metastatic breast cancer developed a dark erythema on the dorsal surface of both hands and excoriation of the skin of the palmar surfaces of both hands which worsened despite continuing daily topical triamcinolone 0.1% ointment. Skin tightness, along with significant pain, resulted in difficulty ambulating. The rash was diagnosed as PATEO by the Dermatology consult service. Hydrocortisone 2.5% cream applied twice daily and mupirocin 2% cream applied three times daily was prescribed and subsequently nab-paclitaxel was discontinued.

Discussion

PATEO is clinically distinct from traditional palmar-plantar erythrodysesthesia (hand foot syndrome) associated with anthracyclines, antimetabolites, or multikinase inhibitors with unique clinical manifestations. The erythema in PATEO appears on the dorsum of the hand as opposed to the palmar surface and around the metacarpal joints. In addition, the thenar eminence and periarticular area of the Achilles tendon are often involved with erythema and violaceous plaques which may blister. Nail changes including discoloration, paronychia, onycholysis and exudation are observed in more severe cases.

Conclusion

This case study suggests PATEO may also be induced by the taxane molecule in the protein bound formulation and may be a risk for all patients receiving taxane therapies.

Objectives

Glycodelin is an immunomodulatory protein with high impact during the establishment of pregnancy and implantation of the trophoblast. In recent years, studies have demonstrated that glycodelin is expressed in different tumor entities. Here we show a case report of a male NSCLC patient with a high glycodelin gene (PAEP) and protein expression in the tumor and the serum.

Materials and methods

The qPCR data, immunohistochemical stainings of glycodelin in the primary tumor and the metastasis as well as the measurements of glycodelin in the serum were connected and analyzed with the clinical and pathological data of the patient.

Results

CT scans of the patient revealed temporarily unclear infiltrations of the lung. The primary tumor of this patient highly expressed the glycodelin gene product (PAEP) as well as the glycodelin protein. Moreover, glycodelin was secreted into the blood and the concentration correlated with the patient's follow-up.

Conclusions

With this case report of a male patient we demonstrate that the pregnancy associated protein glycodelin might be a useful biomarker to monitor disease progression in NSCLC patients.

What is already known about this subject?

After nearly 20 years of development, laparoscopic surgery for colon cancer has emerged as the standard procedure compared to open surgery with similar oncologic outcomes and superior perioperative results. Usually, an abdominal incision is required for anastomosis and specimen extraction for laparoscopic colon surgery. Recently, natural orifice specimen extraction (NOSE) and intracorporeal anastomosis have been proposed to improve the quality of laparoscopic colon resections. This approach can eliminate a larger abdominal incision other than that for trocar placement. However, intracorporeal anastomosis is the major challenge in laparoscopic surgery. Technique of delta-shaped anastomosis which was used for the gastric cancer surgery was reported firstly in 2002. and there was no report on the feasibility and safety of totally laparoscopic resection with delta-shaped anastomosis for colon cancer surgery till now. we describe this simple and safe technique of intracorporeally delta-shaped anastomosis in sigmoid colectomy combined with transvaginal extraction of the specimen.

What are the new findings?

Natural orifice specimen extraction and intracorporeal anastomosis have been proposed to improve the quality of laparoscopic colon resections. This case report demonstrates that the technical innovations of transvaginal specimen extraction and an intracorporeal delta-shaped anastomosis is considered a more feasible and safer procedure, and obesity does not adversely affect the outcomes of this technique with respect to postoperative recovery.

How might it impact on clinical practice in the foreseeable future?

This case report describes the feasibility, safety and shortterm outcome of an intracorporeal delta-shaped anastomosis technique for laparoscopic sigmoid colectomy combined with transvaginal extraction of the specimen in an obese patient. Our findings suggest that this technique is more feasible and safer for patients with sigmoid colon cancer than other natural orifice specimen extraction approaches and that obesity does not adversely affect the outcome of this technique with respect to postoperative recovery. We suggest that intracorporeal deltashaped anastomosis and transvaginal specimen extraction may be an appropriate technique for sigmoid colectomy without complications in suitable patients.

Background

Invasive micropapillary carcinoma (IMPC) of the breast is a rare and aggressive variant of invasive ductal carcinoma. IMPC has been reported to account for 3–6% of all breast cancers, and these tumors have been associated with a strong tendency to invade lymphatics with early spread to regional lymph nodes.

Patients and methods

We present a case of this rare type of breast cancer diagnosed in a male patient and summarize the current literature to date.

Results

Review of the literature on invasive micropapillary breast carcinoma revealed 27 retrospective cohort studies and case series. Significant heterogeneity of inclusion criteria and follow up data prevented meta-analysis. Tumors with an IMPC component demonstrated an early and high rate of lymphatic metastasis compared to invasive ductal carcinoma, however, no significant association was found between IMPC and decreased overall survival.

Conclusions

The IMPC data currently available indicates a strong trend towards a higher initial stage at diagnosis and possibly an increased risk of loco-regional recurrence, but remains underpowered to elucidate the prognostic effect of IMPC phenotype on survival. Further studies are warranted to establish the potential of this unique histologic phenotype to serve as a prognostic indicator and guide tumor-specific oncologic therapy.