Case Reports in Oncology最新文献

Introduction: We describe a case of severe hypomagnesemia that occurred during treatment with carboplatin (CBDCA) and nanoparticle albumin-bound paclitaxel (nab-PTX) for lung adenocarcinoma when co-administered with vonoprazan.

Case presentation: A man in his 70s was diagnosed with stage IIIA lung adenocarcinoma and received CBDCA and nab-PTX as the first-line treatment. The patient had been taking omeprazole 10 mg once daily (for >3 years) for gastroesophageal reflux disease, but it was switched to lansoprazole 15 mg because of hospital's adopted medication. During the first treatment cycle, his serum creatinine levels increased from 1.0 to 1.5 mg/dL, suggesting CBDCA-associated renal impairment. Because of gastric discomfort on day 15 of the second cycle, lansoprazole was switched to vonoprazan 10 mg once daily. On day 23 of the second cycle, he developed torsades de pointes and was hospitalized; severe hypomagnesemia (0.4 mg/dL) was detected to be causing the symptoms. Discontinuation of vonoprazan and a single intravenous infusion of 60 mEq magnesium sulfate raised serum magnesium levels to 3.7 mg/dL, and the arrhythmia disappeared. Mild hypomagnesemia (1.4 mg/dL) reappeared 5 days later, and an additional intravenous infusion of 20 mEq magnesium sulfate with subsequent oral magnesium oxide (1,980 mg/day) resolved the symptoms. CBDCA was discontinued and nab-PTX monotherapy was continued. Vonoprazan was resumed owing to gastric discomfort relapse; however, grade ≥2 hypomagnesemia did not reappear later.

Conclusions: This case highlights the risk of severe hypomagnesemia in patients with CBDCA and vonoprazan co-administration; therefore, regular monitoring of serum magnesium levels during the treatment is crucial.

Introduction: Breast cancer typically metastasizes to axillary, internal mammary and supraclavicular lymph node chains. In contrast, occult breast cancer (OBC), a rare form of breast cancer, usually presents as axillary lymphadenopathy and rarely metastasizes regionally or distally.

Case presentation: In this case report, we present a 45-year-old female patient with unusual presentation of breast cancer initially as axillary lymphadenopathy without breast mass. She was diagnosed by magnetic resonance imaging as OBC and later presented with a rare pathological spread to the ipsilateral subscapular region. The retro-scapular nodal disease was first detected via follow-up computed tomography scan and confirmed by positron emission tomography after 18 months of her initial diagnoses. This occurred following completion of OBC management, which included neoadjuvant chemotherapy, axillary lymph node dissection, without mastectomy, followed by adjuvant radiation treatment to regional lymph nodes and ipsilateral whole breast. Her recurrent nodal disease was subsequently managed by surgical resection followed by radiation therapy to surgical bed.

Conclusion: This case report emphasizes the diverse locations where metastatic breast cancer can manifest and underscores the advancements in diagnostic tools that have enhanced the detection of these metastatic sites.

Introduction: The diagnosis of metastatic iris tumor is made by a fine-needle aspiration biopsy of part of the solid component of the tumor and tumor cells seeded in the anterior chamber; however, sometimes the diagnosis is not made due to insufficient sample volumes. We report a case of metastatic iris tumor in which measurement of tumor marker levels in the aqueous humor together with fine needle aspiration cytology contributed to the diagnosis.

Case report: An 80-year-old Japanese woman was referred to our hospital because of an iris mass. Six months before the initial visit, the patient was diagnosed with adenocarcinoma of the cecum. Slit-lamp microscopy revealed an elevated iris mass. Fine-needle aspiration cytology suggested adenocarcinoma. The carcinoembryonic antigen (CEA) level in the anterior chamber was 5,716.1 ng/mL, and serum CEA level measured on the same day were 678.5 ng/mL. These data indicated CEA levels synchronously elevated in both anterior chamber and serum. Based on aspiration cytology and high CEA levels of anterior chamber, she was diagnosed with metastatic iris tumor derived from adenocarcinoma of the cecum. One month after the initial visit, right eye irradiation was performed for metastatic iris tumor.

Conclusions: Measurement of tumor marker levels in the aqueous humor, together with fine needle aspiration cytology of the tumor, contributes to the diagnosis of metastatic iris tumors.

Introduction: Metastasis to the central nervous system (CNS) is frequently observed in human epidermal growth factor receptor (HER2)-positive breast cancer, leading to reduced quality of life and poor prognosis. Brain metastases (BMs) are common, whereas spinal cord metastases are rare and no standardized treatment approach has been reported for their management. Herein, we report the outcomes of treatment with trastuzumab deruxtecan (T-DXd) in a patient with BMs and intramedullary spinal cord metastasis (ISCM) and another patient with BMs.

Case presentation: The first patient was a woman in her 30s. After the surgery for HER2-positive right breast cancer, T-DXd was used as fourth-line treatment for multiple BMs and ISCM. Both the BMs and ISCM reduced, and partial response was maintained for 12 months. Grade 1 fatigue was the only adverse event observed in this patient. The second patient was a woman in her 40 s with multiple BMs after primary treatment for HER2-positive right breast cancer, as well as multiple bone and lymphoid node metastases. T-DXd was administered as second-line treatment. The multiple BMs have now shrunk, and the primary tumor and bone/lymph node metastases have not shown significant changes; the patient has maintained partial response for 6 months.

Conclusion: Metastasis to the CNS has a very poor prognosis and limited therapeutic response because it is difficult for drugs to cross the blood-brain barrier. However, T-DXd has yielded positive results for BMs in clinical trials. Additionally, a therapeutic effect of T-DXd on ISCM and BMs was observed in the reported cases.

Introduction: Colorectal cancer (CRC), the third most prevalent malignancy globally, can present with complications such as bleeding, obstruction, and, less commonly, perforation. These complications are associated with significant morbidity and mortality, demanding timely recognition and intervention. Unusual initial symptoms can obscure the clinical picture, delaying diagnosis, and treatment.

Case presentation: We report a 50-year-old male with a history of rectosigmoid adenocarcinoma treated with surgery and chemoradiotherapy, presenting with atypical symptoms of intractable hiccups, watery diarrhea, and vomiting. Initial imaging indicated an ileostomy site perforation with signs of ischemic colitis. Exploratory laparotomy revealed a perforation at the splenic flexure, ischemic colitis, and a stenosing rectosigmoid tumor. A total colectomy with end ileostomy was performed, leading to resolution of symptoms and stabilization of the patient.

Conclusion: This case emphasizes the importance of recognizing atypical presentations of CRC and its complications. Prompt and comprehensive diagnostic evaluations followed by appropriate surgical intervention can improve outcomes and prevent further deterioration. Early recognition of unusual symptoms is critical in guiding effective management.

Introduction: Melanoma often metastasizes to the liver, leading to significant morbidity and mortality. Liver injury can also occur due to hepatitis caused by immunotherapy used in the treatment of melanoma.

Case presentation: This case report presents a 38-year-old male diagnosed with advanced melanoma who experienced acute liver failure (ALF) initially thought to be a side effect of immunotherapy. Despite following aggressive supportive care as per the latest guidelines, the patient's condition deteriorated rapidly. It was discovered that the patient had liver metastases. As the tumor had a positive BRAF mutation, we opted for invasive treatment with therapeutic plasma exchange to restore liver function and create the conditions for initiating treatment with BRAF/MEK inhibitors. After the use of a liver support device, the liver function was resolved, and a BRAF/MEK inhibitor was introduced. After 2 months of targeted therapy, a favorable effect and good melanoma control are observed.

Conclusion: The report underscores the complexity of managing melanoma with liver metastasis and the urgent need for advancements in treatment modalities ALF in oncology patients. We suggest that invasive treatment methods, such as liver support system devices, should be considered in well-selected oncology patients, even in advanced stages of disease.

Introduction: Brain tumors are the most common solid tumors in pediatric oncology. Advances in the treatment of childhood brain tumors have led to increased survival; however, treatment-related morbidity remains high. The risk of developing overweight/obesity or significant weight gain is commonly observed in children with a brain tumor often due to hypothalamic damage as a result of radiation therapy, surgery, or the tumor itself. This may be accompanied by endocrinopathies such as diabetes insipidus and central precocious puberty in survivors of a childhood brain tumor. Lifestyle intervention strategies are often ineffective in preventing and managing obesity. Patients have difficulty with adherence to dietary interventions due to prolonged exposure to high-dose steroids, compromised physical health due to the disease process, or limitations in mobility as a result of excessive weight gain or the sequelae of the tumor management. There are no effective interventions to prevent or manage obesity in this patient population.

Case presentation: We describe a case report of a 11-year-old female who underwent treatment for a ganglioglioma, WHO grade 1, and simultaneously experienced nearly 100-kg weight gain. After several unsuccessful attempts at lifestyle interventions, she was referred to endocrinology and prescribed a GLP-1 receptor agonist, semaglutide. Following treatment with semaglutide, significant weight loss was observed. Importantly, the patient reported enhanced quality of life and social activity.

Conclusion: Anti-obesity medications are promising treatment options for this vulnerable patient group. Additional research is warranted to examine their use for the prevention and treatment of obesity in children with a brain tumor.

Introduction: Docetaxel is the first-line drug that has been proved to improve the overall survival of men with metastatic hormone-sensitive prostate cancer (mHSPC). For patients who survive the prostate cancer, they may be at risk of secondary neoplasm, especially for the therapy-related myelodysplastic syndrome or therapy-related acute myeloid leukemia (t-AML).

Case presentation: We reported a 44-year-old man with prostate cancer (cT4N1M1c) who developed t-AML following docetaxel chemotherapy. Typically, the t-AML in our case was characterized by an aberrant karyotype t(15;17)(q22;q21).

Conclusions: This case is, to our knowledge, the first time to report a patient with mHSPC who developed therapy-related acute promyelocytic leukemia following docetaxel chemotherapy, suggesting that docetaxel might contribute to the induction of t-AML.

Introduction: Lung cancer in the transplanted organ is an extremely rare occurrence with very few cases reported. The use of stereotactic body radiotherapy (SBRT) for medically inoperable early stage non-small cell lung cancer is an option to treat an early stage lung adenocarcinoma on a transplanted lung.

Case presentation: We report the case of a 63-year-old woman with a history of hypersensitivity pneumonitis, who underwent a right lung transplant in 2010 and developed pulmonary adenocarcinoma, stage IA2, in 2023. The patient was ineligible for surgical management and was referred for SBRT. The treatment was administered with a total dose of 48 Gy in 4 fractions in December 2023. The nodule remained stable at 9-month follow-up, with post-radiogenic pneumonitis observed. Pulmonary function remained stable after treatment.

Conclusions: This case shows that SBRT on a transplanted lung cancer seems to be safe, even maintaining a standard SBRT fractionation, with good early local control. Careful consideration of dose, fractionation, and potential toxicities is essential in managing these complex cases, always in close cooperation with the transplant medical team.

Introduction: Pseudoaneurysm following gynecologic cancer surgery is a rare complication that can become fatal when it ruptures. Common sites of pseudoaneurysms are the external iliac artery, hypogastric artery, and aorta, which are located around the lymphadenectomy site. There are no previous reports of ruptured inferior epigastric (IEA) artery pseudoaneurysms after gynecologic cancer surgery. We report a case of intraperitoneal bleeding induced by a ruptured IEA pseudoaneurysm following interval debulking surgery for stage IVB ovarian cancer.

Case presentation: The patient underwent total abdominal simple hysterectomy, bilateral salpingo-oophorectomy, omentectomy, ileocolic resection, and peritonectomy around the ileocecal area after 5 cycles of neoadjuvant chemotherapy. The patient suddenly presented with loss of consciousness and reduced blood pressure on postoperative day 20. Her blood hemoglobin levels also decreased. Contrast-enhanced computed tomography revealed a pseudoaneurysm in the right IEA. There were no signs of extravasation from the pseudoaneurysm; however, bloody ascites was observed in the abdominal cavity. A ruptured IEA pseudoaneurysm was suspected, and coil embolization was immediately performed. Her symptoms abated soon after coil embolization, and she remained symptom-free during the 8 months of postoperative follow-up.

Conclusion: Awareness of this rare complication is clinically important for its early detection and treatment.