Case Reports in Oncological Medicine最新文献

Sinonasal malignancies (SNMs) are rare heterogeneous malignancies that frequently present with locally advanced disease. The prognosis is poor when the disease is considered extensive and unresectable. In such cases, a high-dose palliative radiotherapy regimen is often required, but the ideal dose and fractionation have not been established. We detail a 33-year-old male who initially presented with a progressively growing mass over the right cheek. A biopsy of the lesion revealed squamous cell carcinoma (SCC). Imaging revealed a very advanced and unresectable disease with the involvement of several head and neck subsites. He progressed further after receiving induction chemotherapy from an outside institution. The patient requested prompt tumor and symptom control to travel back to his home country. We offered him high-dose split-course palliative radiotherapy in the form of a quad Shot of 14.80 Gy in four fractions twice daily, followed by 30 Gy in five fractions every other day with a 2-week interval. Treatment resulted in excellent clinical response with symptomatic relief in a short time, and the patient could travel back home safely.

Neuroendocrine neoplasms (NENs) are rare in the head and neck region, with the larynx being the most common site. To date, nearly 700 cases of laryngeal neuroendocrine carcinoma (NEC) have been reported in the literature, with an estimated incidence as low as 0.23%. This type of cancer is more prevalent among men aged 50-83 who are heavy smokers. NENs encompass paragangliomas and epithelial neoplasms. The latter categories include neuroendocrine tumors, or typical carcinoids, and NECs, or atypical carcinoids. Due to their nonspecific and often misleading presentation, and given the rarity of this condition, optimal management lacks standardization. Treatment typically involves a combination of surgery, chemotherapy, and radiotherapy. We present a case of supraglottic laryngeal NEC in a 61-year-old female nonsmoker. The patient underwent endoscopic excision followed by adjuvant radiotherapy.

Introduction: Uterine leiomyomas are a frequent finding in women of reproductive age. However, rare, unusual growth patterns exist, such as atypical, cellular, mitotically active, myxoid, and epithelioid leiomyomas, and present a major concern as they mimic highly malignant uterine tumors such as uterine leiomyosarcomas. An example of such cases is the epithelial type leiomyoma which is the subject of our report in a 35-year-old female. Case: A 35-year-old, nulliparous lady presented with abnormal uterine bleeding to the emergency department. Workup revealed a suspicious uterine mass that was extending from the intramural part of the fundus down the cervical os. The patient was managed by open myomectomy without complications. The final pathology report revealed an extremely rare benign epithelial type leiomyoma, no malignancy, areas with minimal atypia and low mitotic activity (< 5/10 high power fields), and areas of focal necroses (possibly ischemic type) were seen. No coagulative tumor necrosis was noted. Conclusion: Uterine leiomyomas are a common pathology of the uterus that can be confused with malignant tumors, especially in the setting of unusual growth patterns such as the epitheloid leiomyomas. Definitive management involves myomectomies with regular follow-up with favourable prognosis. It is important to properly manage these cases to avoid the overdiagnosis and mistreatment not to mention the repercussion of false diagnoses on the patient's mental health and well-being.

Chronic lymphocytic leukemia (CLL) typically presents as an indolent disease with a benign disposition in most patients. In select patients, CLL can progress into a more aggressive disease via its original morphology, following a Richter transformation to an alternative non-Hodgkin's lymphoma, or with the concomitant development of multiple myeloma. In an extremely rare subset of individuals with CLL, an extramedullary plasmacytoma may coexist. This case report seeks to describe the diagnosis and treatment of a patient with concurrent CLL and a plasmacytoma.

Introduction: Neuroendocrine/small-cell prostate cancer (NEPC) is a rare and aggressive subtype of prostate cancer, which typically develops after prolonged treatment for metastatic castration-resistant disease, but can, less commonly, occur de novo. Case Presentation: We describe a case of de novo NEPC in a tumor with mixed pathology including acinar adenocarcinoma and neuroendocrine/small-cell carcinoma with rapid progression of metastatic disease. Despite initiation of treatment with androgen deprivation therapy (ADT) and chemotherapy, the patient continued to exhibit progression leading to multiple complications including a large bowel obstruction and ultimately progressive hepatic metastases resulting in liver failure. Conclusion: This case illustrates the clinical presentation and highly aggressive nature of de novo NEPC. Recognizing atypical clinical progression in prostate cancer is critical for the detection of NEPC; however, despite early identification and initiation of treatment, the prognosis remains poor, thus highlighting the need for further study into NEPC biology and novel therapeutic approaches.

This study examines a unique case of a 61-year-old male with a 5-year history of a progressively growing mass above his right shoulder, diagnosed as a dedifferentiated pleomorphic liposarcoma. Using computerized tomography-guided core needle biopsy, the tumour was identified as intermediate to high grade. Surgical removal required preoperative radiotherapy to reduce the size of the tumour. Several unique characteristics set apart this particular case of liposarcoma: its substantial size, its unpredictable growth pattern, its absence of metastasis, and notably, its prolonged period of being untreated. This case report outlines the clinical background, diagnostic procedures, and treatment modalities employed in managing this condition, emphasizing a localized dual therapy approach combining radiotherapy and surgery. Emphasis is placed on distinguishing liposarcoma from lipoblastoma, a benign adipocyte tumour, to facilitate accurate diagnosis and appropriate treatment selection. The positive result achieved in this case could provide valuable insights for the future treatment and management of similarly sized aggressive tumours.

Uterine metastases from extragenital sites are rare. We present a case of a woman who had undergone surgery for small intestinal cancer and subsequently developed metastases in her left ovary and uterus. A nulliparous woman in her 50s underwent laparoscopic partial small bowel resection with lymph node dissection for small intestinal cancer. Five months later, computed tomography (CT) revealed a left ovarian tumor and ascites. She underwent bilateral adnexectomy and adjuvant chemotherapy, and the ovarian tumor was diagnosed as a small intestinal cancer metastasis. Two years after the small intestinal cancer surgery, a positron emission tomography (PET)-CT scan revealed a uterine accumulation. Cervical cytology was negative for intraepithelial lesion or malignancy. Endometrial histology showed an adenocarcinoma of the uterus. The patient underwent total abdominal hysterectomy followed by adjuvant chemotherapy. Histopathology and immunohistochemistry of the uterine tumor revealed that it was a metastasis of small intestinal cancer (Cytokeratin 7 [CK7] [-], Cytokeratin 20 [CK20] [+], Special AT-Rich Sequence-Binding Protein 2 [SATB2] [+], Paired Box Gene 2 [PAX2] [-], and estrogen receptor [ER] [-]). In patients with cancer, histopathology and immunohistochemistry are important for distinguishing between primary and metastatic tumors and for guiding the choice of treatment.

Desmoid tumors (DTs) are rare and locally aggressive with a high rate of local recurrence even with optimal surgical resection. Systemic treatments are often utilized for desmoid cases with high risk of surgical morbidity or for local and symptomatic control of recurrent disease. However, the systemic treatment options for DTs are limited with limited responses. Avapritinib is a tyrosine kinase inhibitor (TKI) approved in 2020 for adults with unresectable or metastatic gastrointestinal (GI) stromal tumors (GISTs) harboring a platelet-derived growth factor receptor alpha (PDGFRA) Exon 18 mutation, including D842V mutations. In this case report, we describe a 55-year-old man with a history of D842V-mutant gastric GIST who presented several years after complete resection of the GIST with an enlarging soft tissue mass in the small intestine. After a nondiagnostic biopsy, the patient was started on avapritinib due to concerns for recurrent D842V-mutant GIST. The tumor had a partial response to treatment by RECIST 1.1 criteria, and the patient underwent surgical resection. The final pathology report revealed a sporadic DT. To our knowledge, this is the first known description of the activity of avapritinib in the treatment of a sporadic mesenteric DT, which is relevant given the limited treatment options for patients with this diagnosis. This clinical finding may be worth exploring in a dedicated clinical trial.

Pseudomyxoma peritonei (PMP) is a well-known entity in gastrointestinal and ovarian tumors of mucinous histology. It has important implications on prognosis depending on whether seen in conjunction with a benign or a malignant tumor. In the current report, we describe a case of PMP in a case of advanced endocervical adenocarcinoma of the cervix which was managed surgically.

Pediatric chronic myeloid leukemia (pCML) is a rare malignancy accounting for only 2%-3% of all childhood leukemias. Due to this rarity, familiarity with pCML is limited among most pediatric practitioners, including even pediatric hemato-oncologists. In low- and middle-income countries (LMICs), limited financial resources and limited data specific to pCML represent obstacles that healthcare providers must face in diagnosing and treating this rare condition in children. The International CML Foundation (iCMLf) is improving outcomes for people with CML in these countries where resources, diagnostics, and access to medicines may be limited (https://www.cml-foundation.org/lmic-programs.html). Virtual meetings with the purpose of teaching participating pediatricians from LMICs of defined geographical regions were organised by the iCMLf in 2023. At a virtual meeting of the South Asia region, the case of a 14-year-old Indian boy was presented diagnosed with CML in a chronic phase complicated by priapism and loss of vision in his left eye due to hyperleukocytosis. Key aspects of this case are discussed in-depth from the perspective of (i) a pediatric hemato-oncologist practicing in a high-income country, (ii) a pediatric hemato-oncologist practicing in a LMIC, (iii) an adult CML hematologist, and (iv) from the iCMLf in improving the care of children with CML worldwide. Thus by discussing a multifaceted complicated case of pCML in written form as well as pointing to the pediatric module of the iCMLf Knowledge Centre will hopefully contribute to minimize existing knowledge gaps in a rare pediatric malignancy.