Case Reports in Oncological Medicine最新文献

Granulocytic sarcoma (GS) is an extramedullary accumulation of proliferating myeloblasts, most commonly seen in patients with acute myeloid leukemia (AML) but rarely associated with chronic myeloid leukemia, myelodysplastic syndromes, or myeloproliferative neoplasms. The skin is the most frequent site of extramedullary relapse, followed by the mediastinum, gingiva, ear, lymph nodes, central nervous system, and testis. We report a case of a 38-year-old female who presented to our clinic with abnormal vaginal bleeding. She had a history of bone marrow transplantation 5 years ago for AML. Based on clinical suspicion, a cervical biopsy was performed, which confirmed the diagnosis of GS. Although GS involving the female reproductive tract is rare, it should be considered in the differential diagnosis of abnormal gynecologic symptoms in patients with a history of AML.

Immune checkpoint inhibitors (ICIs), such as pembrolizumab, have transformed cancer treatment by enhancing antitumour immunity. However, they are associated with immune-related adverse events (irAEs), including endocrinopathies like adrenal insufficiency. While existing literature extensively covers the risk of pembrolizumab-induced adrenal insufficiency, this case highlights the consequences of failing to act on an abnormal pretreatment cortisol result, leading to delayed diagnosis and clinical deterioration. We report the case of a 76-year-old male with metastatic squamous cell carcinoma (SCC) of the oesophagus undergoing treatment with pembrolizumab. A routine pretreatment blood test in mid-September revealed a cortisol level of 55 nmol/L (low), but this result was not flagged or acted upon. Three weeks later, the patient presented with worsening lethargy, vomiting and hyponatraemia. Follow-up testing confirmed persistently low cortisol levels, leading to a delayed diagnosis of adrenal insufficiency. Hydrocortisone replacement therapy was initiated, with subsequent symptom improvement. This case underscores the need for rigorous pretreatment hormone profiling, systematic review of laboratory test results and safeguarding mechanisms such as automated alerts for abnormal findings. Implementing structured endocrine monitoring in immunotherapy prescribing protocols could prevent similar occurrences and improve patient outcomes.

Chronic eosinophilic leukemia (CEL) belongs to the group of chronic myeloproliferative neoplasms characterized by the persistence of an absolute eosinophil count (AEC) > 1.5 × 10⁹/L for 1-6 months and is accompanied by organ damage. The new World Health Organization criteria for the diagnosis of CEL are the presence of the cytogenetic alteration FIP1L1::PDGFRA as an oncogene; in its absence, morphological criteria in bone marrow define the diagnosis with blasts > 5% and < 20% and in peripheral blood with > 2% of blasts and eosinophilia >1.5 × 10⁹/L. The current study describes the case of a 60-year-old man who was admitted to the internal medicine department in critical condition with fever, cough, dyspnea, shortness of breath, and intense abdominal pain, and his spleen had the following measurements: 8-8-10 cm. The complete blood count showed hemoglobin 8.5 g/dL, platelets92 × 10⁹/L, leukocytes105.97 × 10⁹/L, total neutrophils31.79 × 10⁹/L, AEC69.40 × 10⁹/L, and lymphocytes4.23 × 10⁹/L, and the bone marrow analysis revealed 25% eosinophils and 12% myeloblasts. Thorax and abdomen computed tomography showed interstitial infiltrate, pleural effusion, and splenomegaly. Endoscopy showed ulcerative lesions in the digestive tract. This case underscores the crucial role of both bone marrow and peripheral blood morphological criteria in diagnosing CEL. This rare disease manifests at an advanced stage with complex clinical features but responds well to cytarabine.

Bladder cancer is one of the most common cancers worldwide; however, leptomeningeal carcinomatosis (LMC) is an uncommon and understudied complication. We report a male patient diagnosed with LMC while in apparent clinical remission of metastatic urothelial carcinoma of the bladder. He presented with headaches, vision changes, hearing impairment, and leg weakness. Imaging of the brain and spinal cord was negative; however, the cerebrospinal fluid was positive for malignant cells consistent with high-grade urothelial carcinoma, confirming the diagnosis of LMC. Conservative measures and whole-brain radiation were ineffective, and he died 2 months after his LMC diagnosis. Literature review identified 45 cases of LMC due to bladder cancer, and we summarize these data. It is unclear whether new and more effective systemic treatment approaches for urothelial carcinoma will also reduce the risk of LMC or provide better treatment for LMC, supporting a need for more study of this devastating complication.

Renal cell carcinoma (RCC) commonly metastasizes to the lung, bone, and liver. Cardiac metastasis, especially in the absence of IVC involvement, is considered extremely rare. We report an 81-year-old male with a history of clear cell RCC who underwent radical nephrectomy, and 10 years later, he presented with acute cardiac tamponade secondary to pathologically confirmed late myocardial metastasis.

Introduction: Head and neck cancers are one of the most common cancers globally. Locoregional recurrence or distant metastasis is a common mode of recurrence and should be treated curatively, where feasible. We present a case of an elderly gentleman treated with reirradiation for nodal metastases and lung metastases ablated with single-fraction SBRT. Case Summary: An elderly 73-year-old gentleman treated with definitive radiotherapy 3 years ago for carcinoma of the base of the tongue presented with the complaint of left neck swelling for 3 weeks. A 2 × 3 cm left Level II lymph node was palpable with skin involvement. The positron emission tomography (PET) was suggestive of a left Level II cervical node measuring 4 × 4 × 3.2 cm, encasing the carotid artery and involving the skin, and a 3 × 2 cm right lower lobe lung lesion, suggestive of a metachronous lung primary or metastasis. The neck node was deemed unresectable due to more than 180-degree contact with vessels. The patient was unwilling to undergo a biopsy of the lung. Given the age, performance status and oligometastatic presentation, the patient was planned for radical intent treatment to both the neck node and the lung lesion. He was treated with reirradiation to the neck node with a dose of 66 Gy in 33 fractions over 6.5 weeks and SBRT 34 Gy in a single fraction to the lung lesion. He developed neck soft tissue necrosis, at 1.5 years after radiation, which resolved on antibiotics. The patient remains clinically well, and the PET scan performed at 1 and 2 years following radiation showed complete response with no new metastasis. Conclusion: Radical intent can be considered in oligometastatic head and neck cancers. Reirradiation is a treatment option for patients with recurrent head and neck cancers. Single-fraction SBRT is one of the recommended dose schedules for lung metastases.

Colitis is a common side effect of all currently approved immune checkpoint inhibitors (ICIs). Vedolizumab is an α ₄ β ₇ monoclonal antibody approved for treating inflammatory bowel disease (IBD) and is commonly used off-label to manage checkpoint inhibitor colitis (CIC). Previous studies have attempted dose escalation of vedolizumab for clinically unresponsive IBD patients and have been able to achieve clinical remission in 49.6% of these patients without an associated increase in adverse events. However, this has yet to be reported in patients with CIC. Here, we report on two patients who developed CIC after being treated with ICIs for metastatic cancer and received a double dose of vedolizumab. Both patients' colitis was initially treated with infliximab, steroids, and standard 300-mg vedolizumab dosage with an incomplete response. When administered a double dose of 600-mg vedolizumab, colitis symptoms were resolved without further recurrence or the need for treatment in both patients. This case series outlines effective clinical experience in treating patients with CIC refractory to standard vedolizumab dosage and supports further study of vedolizumab dose escalation in this patient population.

This case report describes a rare occurrence of a single isolated sacral metastasis in a 59-year-old male with clear cell renal cell carcinoma (ccRCC). The patient presented with progressive lower back pain and sacral numbness following a fall. Initial imaging revealed a destructive lytic lesion in the S1-S2 region and a left renal mass. A CT-guided biopsy of the sacral lesion confirmed metastatic ccRCC. PET-CT confirmed no additional metastases. Multidisciplinary management included partial left nephrectomy for the primary renal tumor, stereotactic body radiotherapy (SBRT; 45 Gy/15 fractions) targeting the sacral metastasis, and immunotherapy with sunitinib. The patient experienced significant pain relief within 1-week post radiotherapy and demonstrated stable disease with near-resolution of the sacral lesion at 3-month follow-up. At 12 months, imaging confirmed sustained disease stability. This case highlights the importance of considering metastatic RCC in patients with isolated sacral lesions, even in the absence of disseminated disease, and underscores the efficacy of combining localized ablation, radiotherapy, and targeted systemic therapy. Early diagnosis and a tailored multidisciplinary approach are critical for optimizing outcomes in such rare presentations.

Introduction: Prostate adenocarcinoma is among the leading malignant neoplastic processes in overall incidence and among the leaders of cancer-related deaths. Clinically, there is a higher risk of development in males over 50, and suspicion is increased in all cases of elevated prostate-specific antigen (PSA) levels. While the most common histologies are of conventional ductal and acinar prostatic adenocarcinoma, there are some exceedingly rare histological patterns and subtypes that vary from conventional carcinomas not only in their histological makeup but also in their presentation and aggressiveness. Case Presentations: Herein, we report two cases of male patients aged 75 and 60 years who presented to our institution with the leading complaint of urinary retention and gross hematuria and concomitant hydronephrosis. In both patients, the PSA levels were within normal reference values. As such, they were scheduled for transurethral resection of the prostate, with histopathology of the resected specimens showing a pleomorphic tumor process with foci of pseudoacinar structures comprised of large atypical cells with large hyperchromic nuclei, some of which had a monstrous appearance, solid tumor cell aggregates, sheets, and single tumor cells invading the parenchyma, represented mainly by large tumor cells with macroanisokaryosis, nuclear hyperchromasia, and pronounced pleomorphism. Conclusion: Pleomorphic giant cell prostatic carcinomas rarely present with elevated PSA or specific imaging findings and are often diagnosed incidentally, further contributing to their rarity.

Metastatic ampullary carcinoma (AC) almost always carries a poor prognosis. We present a remarkable case of a 69-year-old male with Stage IV pancreaticobiliary-type AC who achieved a complete remission after 45 months of palliative modified FOLFIRINOX chemotherapy (5-fluorouracil, oxaliplatin, leucovorin, irinotecan). This unexpected outcome challenges the conventional understanding of the natural history of advanced AC. Furthermore, molecular analysis revealed a pathogenic PALB2 mutation, along with variants of unknown significance in the POLD1 and RAD50 genes, coding for enzymes involved in various deoxyribonucleic acid (DNA) repair pathways. These findings raise questions about their potential influence on treatment response and prognosis. This case underscores the need for further investigation into the role of molecular alterations and personalized approaches in managing advanced AC.