Case Reports in Oncology最新文献

Introduction: Investigation on virus-host interaction may provide new clues for antitumor immunotherapy.

Case presentation: In this case report, we describe an unusual case of B-cell non-Hodgkin lymphoma in an aged woman who recovered following SARS-COV-2 infection. We discuss the case and suggest that virus induced cross-reactivity against tumor account for the remission.

Conclusion: Mapping epitope characteristics on B cell non-Hodgkin lymphoma antigen and on SARS-COV-2 antigen may provide much needed information for antigen based antitumor immune therapy in the future.

Introduction: Osteochondromas are benign tumors that arise primarily in the metaphyseal region of long bones. The malignant transformation rate is estimated to be less than 1% and 1-3% in solitary and multiple osteochondromas, respectively. Transformation to osteosarcoma is very rare. Little information is available on treatment or outcome. A rare case of osteosarcoma arising from hereditary multiple osteochondromas of the right iliac bone is reported.

Case presentation: A 66-year-old woman presented with recurrent right abdominal pain. Computed tomography (CT) showed a mass protruding into the pelvic cavity, 9 cm × 7 cm × 7 cm, with bone destruction and internal calcification in the right iliac bone. A CT-guided biopsy was performed, and the diagnosis was osteosarcoma. After one course of chemotherapy with doxorubicin and ifosfamide, extensive resection of the tumor was performed. The pathology showed proliferation of highly pleomorphic dysplastic cells with bone formation inside the tumor just below the osteochondroma tissue, which led to the diagnosis of osteosarcoma arising from the osteochondroma. Three years after surgery, there was no evidence of recurrence or metastasis, and the patient was able to walk unassisted.

Conclusion: A case of osteosarcoma arising from an iliac lesion of hereditary multiple osteochondromas was described. Although no recurrence or metastasis has been observed 3 years after surgery, further follow-up is necessary due to the short time after surgery.

Introduction: Malignant paragangliomas (M-PGL) are a group of neuroendocrine tumors that originate from chromaffin cells. The most common location for PGL is the head and neck, which comprise 65-70% of all PGL, and the M-PGL accounts for 0.6% of all head and neck cancers. It is a rare tumor, with an incidence of 2-8 per million. Diagnosing PGL can be challenging, and treatment for metastatic disease is usually not curative.

Case presentation: A 66-year-old woman was diagnosed with left cervical pain and laterocervical mass in March 2015. Octreotide scintigraphy showed intense uptake in the cervical mass, two pulmonary micronodules of 4-5 mm, and another lesion in the lumbar region (L3-L4). The final diagnosis was malignant nonsecretory PGL with adjacent tissue involvement and distant metastases. After three different treatments with minimal symptomatic improvement, 177Lu-DOTATATE was requested off-label. With a dose of 7,400 MBq until January 2018, the patient showed remarkable symptomatic pain improvement and a decrease in tumor size.

Conclusion: We believe that our case report provides relevant information that can be considered in similar cases. First, the patient tripled the expected survival in such a clinical setting, and this benefit seems to rely on 177Lu-DOTATATE treatment. Second, we documented an early symptomatic response to this treatment but a long-term delayed volumetric radiographic response.

Introduction: Purpura fulminans is a rare but fatal manifestation of Capnocytophaga canimorsus bacteremia that can present in immunocompromised hosts. This can have a profound impact on patients, including recipients of allogeneic hematopoietic stem cell transplant. Despite aggressive therapy, mortality can be as high as 60% and most patients require amputation of multiple extremities.

Case presentation: We present a 31-year-old woman s/p myeloablative allogeneic transplant, presenting with purpura fulminans and septic shock. She had been on Immunosuppressive therapy with rituximab and tacrolimus. Despite aggressive antibiotic coverage and supportive therapy, although her shock was resuscitated, she had to undergo bilateral below-knee amputations.

Discussion: We attempt to highlight the clinical presentation, pathophysiology and potential therapeutic options for immunocompromised patients presenting with septic shock from C. canimorsus. The importance of pre-transplant counselling on handling and adoption of new pets to prevent zoonotic infections is also discussed. Early recognition and initiation of antibiotics play a crucial role to reduce mortality in patients receiving HSCT.

Introduction: Profuse diarrhea and abdominal discomfort are well-documented symptoms of patients with known colorectal cancer. It is much less common for these patients to present with a chief complaint of gait disturbance and rhabdomyolysis. We present a case of incidentally discovered colorectal carcinoma in a patient who was initially evaluated for progressive weakness and recurrent falls.

Case presentation: A 51-year-old man was admitted to our department for management of rhabdomyolysis in the setting of progressive lower extremity weakness and mechanical falls. He developed abdominal discomfort and bowel changes during his admission, and after further investigation, he was found to have a rectal polyp positive for invasive adenocarcinoma, as well as multiple gluteal abscesses. Workup for metastasis, mutations, and oncogenic biomarkers was unremarkable.

Conclusion: This case is a demonstration of a medically complex patient presentation compounded by multifactorial processes. Future providers may take note that an initial absence of classic gastrointestinal (GI) symptoms does not necessarily rule out underlying GI cancer. Instead, the initial presentation of colorectal adenocarcinoma may manifest with paraneoplastic versus incidental progressive proximal limb weakness prior to GI symptoms such as diarrhea. Additionally, our report demonstrates a case of possible paraneoplastic gluteal abscesses, which may have further contributed to the patient's gait disturbance. However, it is unclear as to whether our patient's various symptoms were directly linked to one another, or if they were incidental co-presentations.

Introduction: Uterine adenosarcoma (UA) is a rare malignant mesenchymal neoplasm characterized by benign epithelial and malignant stromal components. Comprehensive genomic profiling has identified a high frequency of murine double-minute type 2 (MDM2) and cyclin-dependent kinase 4 (CDK4) amplification in UA. However, the significance of these genetic alterations in tumor biology remains poorly understood. This report presents a case of UA with immunohistochemically positive MDM2 and CDK4 expression.

Case presentation: The patient was a 72-year-old woman with a history of genital bleeding. Magnetic resonance imaging revealed an 11 × 5 × 7 cm mass in the endometrial cavity, extending into the uterine cervix. Biopsy of the tumor showed no malignant findings. The patient underwent total abdominal hysterectomy and bilateral salpingo-oophorectomy. Microscopically, the tumor consisted of benign glandular epithelial components and low-grade sarcoma. The diagnosis was UA stage IA, pT1aNxM0. No sarcomatous overgrowth and no myometrial or lymphovascular invasions were observed. Immunohistochemistry confirmed MDM2 and CDK4 expression in the mesenchymal tissue. No recurrence was observed 12 months post-surgery.

Conclusion: The pathological diagnosis of UA was based on histomorphological features. This study demonstrates that immunohistochemistry for MDM2 and CDK4 can help elucidate the molecular genetic features of UA. Further studies are needed to correlate the expression of these genes with the biological behavior of UA.

Introduction: Immune-check-point inhibitors (ICIs) are established in the treatment of many malignancies. Many immune-related adverse events (irAEs) are well described; however, there is less information about opportunistic infections in cancer patients receiving ICIs.

Case presentation: We describe the case of a 62-year-old woman with non-small cell lung cancer, who relapsed after surgical resection and chemotherapy. She received 13 months of pembrolizumab, achieving stable disease, before presenting with suspected pneumonitis 2 weeks prior to departure for an international vacation. She was treated with high-dose corticosteroids and, shortly thereafter, developed severe nocardiosis, requiring venovenous extracorporeal membrane oxygenation and lengthy hospitalization.

Conclusion: To our knowledge, this represents the second known case of pulmonary nocardiosis in a patient on pembrolizumab. Moreover, this is a rarely reported instance of opportunistic bacterial infection following steroid treatment for ICI pneumonitis. This case report emphasizes the risk of bacterial infection associated with ICI pneumonitis, both due to the difficulty of excluding underlying infection at presentation, and the immunosuppression caused by irAE treatment. As such, we suggest that clinicians maintain a high suspicion for potential infection in ICI pneumonitis, and strongly consider initiating infectious workup with regular follow-ups for monitoring. Prophylactic antibiotics could be considered when such monitoring is not possible.

Introduction: Goblet cell adenocarcinoma (GCA) of the appendix is an uncommon type of cancer that includes both epithelial and neuroendocrine features, with goblet cells present. These tumors have traditionally been viewed as one of the more aggressive forms of appendiceal cancer, frequently being diagnosed at a metastatic stage. For patients with stage III-IV disease, the 5-year overall survival rate ranges from 14% to 22%. Due to limited data, the diagnosis and management of GCA are challenging.

Case presentation: We present the case of a 55-year-old female who presented with elevated serum carcinoembryonic antigen levels and a left ovarian tumor. Preoperative imaging indicated a normal appendix. During surgery for suspected ovarian carcinoma, frozen section analysis revealed mucinous adenocarcinoma of the ovary, but distinguishing between primary and metastatic lesions was challenging. Meticulous exploration revealed a firm and thickened appendix, prompting appendectomy and subsequent diagnosis of appendiceal GCA with ovarian metastasis.

Conclusion: Pathologies of the appendix, like GCA, can mimic ovarian tumors despite a normal-looking appendix, complicating diagnosis. Through this case, we underscored the need for careful intraoperative examination of the appendix in patients with mucinous ovarian neoplasms to avoid misdiagnosis and ensure appropriate treatment.

Introduction: Spontaneous tumor regression is the volumetric reduction or complete disappearance of a primary tumor or metastatic sites (single or multiple) without the administration of treatments. This rare phenomenon occurs most commonly in certain types of neoplasms.

Case presentation: In this manuscript, we describe a spontaneous tumor regression in an adult patient followed at the Modena Cancer Center and affected by retroperitoneal inflammatory myofibroblastic tumor, an ultra-rare subtype of sarcoma. Finally, we will provide a concise review of the literature and try to explain the mechanisms underlying the tumor regression described in the clinical case.

Conclusion: The etiopathogenetic mechanisms for spontaneous tumor regression are not yet fully understood and likely involve a complex interplay among immunological mechanisms, growth factors, cytokines, and hormonal factors.

Introduction: Neurolymphomatosis (NL) is a rare condition characterized by the infiltration of malignant lymphoma cells into the peripheral nervous system. The optimal treatment for NL remains unclear, and patients with secondary NL have a poor prognosis. Although early recognition of NL may contribute to successful treatment, the predictive factors for secondary NL are yet to be established.

Case presentation: Here, we present our investigation on the predictive factors for secondary NL, and report two cases of secondary NL with a literature review. We analyzed chromosomal abnormalities in patients with secondary NL and found a common deletion of chromosome 10 and add(11)(p11). The chromosomal abnormalities might be a predictive factor for secondary NL; therefore, confirmation of chromosomal abnormalities can possibly give a hint for early detect of secondary NL. Prompt histopathological examination or imaging techniques can lead to early diagnosis of secondary NL in patients with diffuse large B-cell lymphoma (DLBCL).

Conclusion: When neurological symptoms manifest in patients with DLBCL and there are chromosomal abnormalities, the possible development of secondary NL should be considered.