Case Reports in Oncology最新文献

Introduction: Drug-induced sclerosing cholangitis (SC) is uncommon and has been only rarely reported with paclitaxel, bevacizumab, or trastuzumab deruxtecan (T-DXd). We report a suspected SC following these therapies for metastatic breast cancer, underscoring a possible association with taxane-based chemotherapy and antibody or antibody-drug conjugates.

Case presentation: A 58-year-old woman with metastatic hormone receptor-positive, human epidermal growth factor receptor 2-low breast cancer developed cholangitis 17 days after receiving the first cycle of T-DXd, following prior treatment with paclitaxel and bevacizumab. The symptoms improved with antibiotic therapy. However, fever and jaundice recurred on day 49. Imaging studies revealed intrahepatic and extrahepatic bile duct dilation and stricture. SC was suspected based on imaging and clinical course. Histopathological examination showed fibrosis without evidence of malignancy or infiltration by IgG4-positive cells, raising suspicion of drug-induced SC. Due to repeated episodes of cholangitis, the patient's performance status deteriorated, making further chemotherapy unfeasible. The patient opted for best supportive care and died on day 99.

Conclusion: This case highlights the possibility of SC as a delayed adverse event of anticancer chemotherapy. Clinicians should consider drug-induced SC when unexplained biliary strictures arise during or after chemotherapy, as early recognition may impact prognosis and treatment planning.

Introduction: Multiple primary malignancies (MPM), defined as two or more distinct primary tumors in 1 patient, are uncommon, with synchronous presentations (diagnosed within 6 months) being rarer. The coexistence of retroperitoneal liposarcoma and a synchronous gastrointestinal malignancy, particularly colorectal adenocarcinoma, is an exceptionally rare clinical entity, posing significant diagnostic and therapeutic challenges.

Case presentation: A 63-year-old male presented with fatigue, anorexia, and weight loss. The initial workup revealed microcytic anemia and positive fecal occult blood. While initial endoscopic biopsies were inconclusive, a contrast-enhanced CT scan identified two distinct masses: a large (20 cm) heterogeneous retroperitoneal mass suggestive of liposarcoma and a thickened right colic flexure. The patient underwent a combined en bloc surgical resection, including an extended right hemicolectomy and resection of the retroperitoneal mass with the right kidney. Histopathology confirmed two high-grade primary malignancies: a retroperitoneal pleomorphic liposarcoma (stage IIIb) and a colonic mucinous adenocarcinoma (stage pT3 pN2b). Adjuvant chemotherapy (CAPOX regimen) was initiated for high-risk colon cancer.

Conclusion: This case highlights the necessity of a high index of suspicion for synchronous malignancies in patients with non-specific constitutional symptoms. Comprehensive cross-sectional imaging is crucial for accurate staging. Management requires a multidisciplinary approach to plan complex surgical interventions and tailor adjuvant therapy, often prioritizing the more aggressive or higher stage malignancy. This report underscores the complexity of MPM and the need for individualized patient care.

Introduction: Subungual melanoma is a rare and aggressive variant of acral lentiginous melanoma (ALM), often misdiagnosed in its early stages. It typically affects older individuals and has a poor prognosis due to delayed recognition. Management is further complicated in low-resource or conflict-affected settings.

Case presentation: We report the case of a 52-year-old Syrian male with no significant medical history who presented with an ulcerative lesion on his left hallux. Histopathological evaluation following excisional biopsy and hallux amputation revealed ulcerated malignant melanoma, Clark level V, with subcutaneous invasion but no bone involvement. Regional lymph node dissection identified one metastatic inguinal node (pN1). Despite initial surgical management, the disease progressed within 4 months, with PET-CT revealing hepatic and pulmonary metastases (stage IV). The patient tested negative for BRAF mutations and, due to unavailability of immunotherapy, was treated with systemic chemotherapy (carboplatin and paclitaxel). This case highlights the diagnostic and therapeutic challenges in managing advanced subungual melanoma, particularly in settings with limited access to molecular testing and modern therapies. The lesion's aggressive course and rapid progression despite surgery reflect the poor prognosis associated with late-stage ALM and the necessity of early recognition. Comparisons with similar cases from the literature reveal both unique and shared features in tumor behavior, diagnosis, and treatment strategy.

Conclusion: Subungual melanoma can progress rapidly and metastasize even after seemingly adequate local treatment. Early detection, prompt excision, and access to targeted and immune-based therapies are crucial to improving outcomes. In resource-limited environments, comprehensive care is further hindered, underscoring the importance of global efforts to improve cancer care equity.

Introduction: In gynecologic oncology, para-aortic lymph node dissection is typically performed up to the level of the left renal vein. Although the renal arteries usually originate from the aorta, cranial to the renal veins, their anatomical course varies from person to person, and sometimes, the renal arteries are located within the para-aortic dissection area.

Case presentation: We present a case of endometrial cancer involving three left renal arteries, two of which were located caudal to the renal vein. Preoperative three-dimensional (3D) reconstruction accurately depicted the vascular variation and provided precise measurements from the origin of the inferior mesenteric artery (IMA) to the accessory arteries. During surgery, the IMA was used as a landmark to identify and preserve renal arteries during para-aortic lymph node dissection.

Conclusion: This case demonstrates the practical advantages of preoperative 3D imaging in visualizing complex retroperitoneal vascular variation, ensuring surgical safety, and enhancing anatomical understanding in gynecologic oncology.

Introduction: Fruquintinib is a selective vascular endothelial growth factor receptor inhibitor approved for metastatic colorectal cancer (mCRC) that is refractory to standard therapies. While its efficacy and safety have been demonstrated in phase III trials, data on its use in patients undergoing hemodialysis for end-stage renal disease (ESRD) are lacking. We report the first known case of fruquintinib administration in a patient undergoing maintenance hemodialysis.

Case presentation: A 66-year-old woman with mCRC and ESRD undergoing thrice-weekly hemodialysis received multiple lines of chemotherapy, including FOLFOX, FOLFIRI, and regorafenib. Owing to progressive disease and limited treatment options, fruquintinib was initiated after informed consent was obtained. The starting dose was 3 mg/day, with escalation to 4 mg, and subsequently to 5 mg in later cycles. The drug was administered daily regardless of the dialysis schedule. Adverse events, graded according to the Common Terminology Criteria for Adverse Events (CTCAE) version 5.0, included grade 1 fatigue and diarrhea and grade 3 anemia requiring transfusion, which was attributed to underlying renal anemia rather than fruquintinib. Clinically significant hypertension, electrolyte disturbances, or other toxicities were not observed. Despite acceptable tolerability, computed tomography (CT) after three cycles indicated disease progression.

Conclusion: This case suggests that fruquintinib may be administered safely to selected patients with mCRC on maintenance hemodialysis. Further data are needed to establish dosing strategies and monitor potential toxicities in this population.

Introduction: Acral melanoma (AM) is a rare and biologically distinct subtype of melanoma that exhibits poor responsiveness to immune checkpoint inhibitors (ICIs) and limited treatment options. Relatlimab, a LAG-3 inhibitor, in combination with nivolumab, a PD-1 inhibitor, has recently emerged as a dual ICI strategy targeting T-cell exhaustion.

Case presentation: We report the first documented case of an abscopal effect induced by LAG-3 inhibition and radiation therapy in a man in his 40s with metastatic amelanotic AM of the right foot. The patient progressed after four cycles of relatlimab plus nivolumab, prompting palliative radiation therapy to a bulky, bleeding foot lesion. Remarkably, the tumor began to regress within 1 week of initiating radiation. Two months later, the lesion had nearly resolved, and follow-up imaging demonstrated complete disappearance of pulmonary metastases, consistent with a systemic abscopal response.

Conclusion: This case illustrates the potential synergistic effect of sequential LAG-3/PD-1 inhibition followed by radiation therapy in eliciting systemic immune activation in AM. It represents the first reported instance of an abscopal effect associated with relatlimab-based immunotherapy, suggesting that strategic sequencing of immunotherapy and radiation may be critical in overcoming immune resistance in this challenging melanoma subtype.

Introduction: Enfortumab vedotin (EV), an antibody-drug conjugate targeting Nectin-4, has become a standard treatment option for metastatic urothelial carcinoma (mUC) following failure of platinum-based chemotherapy and immune checkpoint inhibitors. However, adverse events (AEs) such as skin toxicity often necessitate dose modification or temporary discontinuation.

Case presentation: We report the case of a 72-year-old woman with mUC who achieved a long-term partial response to EV despite experiencing grade 2 skin toxicity that required temporary treatment interruption. After symptom resolution, EV was successfully reintroduced at a reduced dose, and clinical response was maintained.

Conclusion: Temporary discontinuation of EV due to AEs followed by intermittent reintroduction resulted in long-term disease control in this patient with mUC. This case suggests that rechallenging EV after treatment interruption may be a feasible approach in selected patients, underscoring the importance of careful AE management in real-world practice.

Introduction: BRAF and MEK inhibitors, specifically dabrafenib and trametinib, have substantially improved treatment outcomes in metastatic melanoma. However, their use in advanced-age patients remains insufficiently studied.

Case presentation: A 90-year-old man with a history of wide excision for cutaneous melanoma developed liver metastases. Core needle biopsy confirmed the presence of a BRAF V600E mutation. The patient was treated with dabrafenib (150 mg twice daily) and trametinib (2 mg once daily). After 6 months, he achieved complete remission of liver metastases, experiencing only mild adverse events, including grade 1 pyrexia and diarrhea.

Conclusion: This case report demonstrates that dabrafenib-trametinib combination therapy is an effective and well-tolerated treatment option for BRAF-mutated metastatic melanoma in advanced-age patients.

Introduction: We report the clinical, imaging, histopathological, and genetic features of a choroidal metastasis originating from a cutaneous melanoma.

Case presentation: A 92-year-old woman presented with an asymptomatic pigmented lesion in her right eye. She had a history of prior cutaneous melanoma. Workup revealed widespread metastases to the liver, lungs, and brain. Histopathology (post-mortem eye) showed melanoma cells of the epithelioid cell type. Genetic analysis was positive for the BRAF V600K variant, confirming the cutaneous origin of the choroidal tumour.

Conclusion: Choroidal metastasis of a cutaneous melanoma is a rare manifestation that can be mistaken for a primary choroidal melanoma. A comprehensive clinical history, histopathology, and genetic analysis are useful in distinguishing between the two entities.

Introduction: The treatment landscape of hormone receptor-positive, HER2-negative (HR+/HER2-) metastatic breast cancer (BC) has been transformed with the advent of cyclin-dependent kinase 4/6 inhibitors (CDK4/6i). While myelosuppression is the most common adverse effect, interstitial lung disease (ILD) has emerged as a rare but potentially severe complication in real-world settings.

Case presentation: A 76-year-old woman with metastatic HR+/HER2- BC developed ILD after approximately 20 months of palbociclib therapy. Treatment discontinuation and high-dose corticosteroids resulted in symptomatic and radiological improvement. A concomitant pneumomediastinum was considered a secondary manifestation of ILD.

Conclusion: ILD is an underrecognized but clinically significant toxicity of CDK4/6i, requiring early diagnosis and prompt intervention to prevent severe respiratory compromise. A high index of clinical suspicion, prompt diagnosis, and rapid treatment strategies are crucial, particularly in elderly patients, to minimize ILD-associated risks and complications. Further research is needed to establish predictive biomarkers and optimize management guidelines for CDK4/6i-induced ILD.