Case Reports in Oncological Medicine最新文献

Cutaneous squamous cell carcinoma (cSCC) is one of the most prevalent malignancies worldwide, and a subset of patients, particularly immunocompromised individuals, will face heightened risks of metastasis and mortality. This report examines two cases of immunocompromised patients treated with a combination of platinum- and taxane-based chemotherapy together with PD-1 inhibition, having progressed after PD-1 monotherapy. The first patient, a 54-year-old man with HIV and recurrent metastatic cSCC, had rapid progression of disease while undergoing PD-1 inhibition with cemiplimab but later achieved tumor control when treated with pembrolizumab, carboplatin, and paclitaxel. The second patient, a 36-year-old man with cystic fibrosis and a history of lung transplantation, had no signs of response to cemiplimab but experienced a partial response when treated with cemiplimab, carboplatin, and paclitaxel. These cases suggest that combining chemotherapy with PD-1 inhibition may help overcome primary resistance to PD-1 therapy in advanced cSCC.

Hypercalcemia of malignancy is a well-known phenomenon in cancer patients, often associated with poor prognosis. The discovery of immune checkpoint inhibitors has revolutionised cancer therapy by improving prognosis in numerous different cancer types. Unfortunately, immune-related adverse events frequently arise, particularly with dual checkpoint inhibition. We present a case of severe hypercalcemia in a 65-year-old woman undergoing treatment for metastasised malignant melanoma. Eleven weeks after initiating ipilimumab-nivolumab, the patient developed severe hypercalcemia, along with inflammation and hepatitis. This was initially presumed to be due to hypercalcemia of malignancy, given the clinical examination, imaging findings and laboratory values potentially consistent with progressive disease. The hypercalcemia responded well to bisphosphonates, intravenous saline and methylprednisolone. Interestingly, fluorodeoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT) performed shortly after hospital discharge showed a complete metabolic remission, thereby making hypercalcemia of malignancy unlikely. Review of her medical history, imaging and laboratory revealed several features consistent with a sarcoid-like reaction. We hypothesise that this reaction led to elevated 1-alpha hydroxylase, thereby facilitating calcitriol-mediated hypercalcemia. In this report, we summarise previously published case reports on immune checkpoint inhibitor-induced hypercalcemia and discuss the various mechanisms that cause hypercalcemia in this rare immune-related adverse event. Immune checkpoint inhibitors can induce production of parathyroid hormone-related protein (PTHrP), calcitriol, and may cause hypocortisolaemia, all of which can disrupt calcium homeostasis. Through this case, we contribute to the growing body of evidence regarding hypercalcemia as an immune-related adverse event and aim to raise awareness among clinicians of this potential complication. Early recognition is critical for this life-threatening condition, as it can be refractory to conventional therapies and may necessitate corticosteroid therapy.

Eosinophilia is a common systemic reaction to allergy, parasitic infection, or drug hypersensitivity. Rarely, it manifests as a paraneoplastic phenomenon, most commonly secondary to hematologic malignancies or extensive metastatic disease in solid tumors. There is scarce literature attributing peripheral eosinophilia to solid organ malignancies, especially gynecologic malignancies. We present the first reported case of peripheral eosinophilia secondary to high-grade endometrial stromal sarcoma (HGESS). A postmenopausal woman presented with weakness, urinary incontinence, and marked peripheral eosinophilia. An unremarkable infectious workup prompted further imaging, which revealed a uterine mass. She underwent total hysterectomy with bilateral salpingo-oophorectomy, after which her eosinophilia resolved. Histopathology confirmed HGESS. One month later, the patient re-presented with recurrent eosinophilia and was found to have new metastatic lesions on CT abdomen/pelvis. She elected to pursue hospice care. This case highlights a rare and atypical presentation of an aggressive uterine malignancy underscoring peripheral eosinophilia as a potential marker of underlying malignancy.

Mitomycin C (MMC) pneumonitis leading to acute respiratory distress syndrome (ARDS) is a rare and life-threatening adverse reaction to MMC. Diagnosing MMC pneumonitis can be challenging as more frequent etiologies such as bacterial infections are often targeted first due to patients being immunocompromised from chemotherapy. We report a case of a middle-aged male who was administered MMC without concomitant vinca alkaloid, who developed ARDS secondary to MMC pneumonitis requiring intubation and intensive care. The patient recovered with steroid treatment after being on antibiotics for many days, and no infectious etiology was ever identified. This case emphasizes the importance of recognizing MMC as a potential cause for pneumonitis which can lead to ARDS and death.

Introduction: Skin cancer is the most prevalent cancer in Iran. While surgical excision is the primary treatment, radiation therapy (RT) plays a crucial role, especially for tumors in critical anatomical locations. This case report evaluates the performance of handmade boluses for skin cancer RT using 6 MV photons. Case Presentation: Two patients with lip squamous cell carcinoma (SCC) and nasal basal cell carcinoma (BCC) were treated using 6 MV photon RT with handmade boluses. Dosimetric evaluation using EBT2 Gafchromic film was performed to verify the delivered radiation doses. For the lip SCC patient, the measured dose was 3.9% higher than the planned 73.85 Gy. For the nasal BCC patient, the measured dose was 3.48% higher than the planned 75.60 Gy, demonstrating the high accuracy of the handmade bolus approach. Discussion: The use of patient-specific, handmade boluses demonstrated several advantages, including reduced air gaps and improved dose delivery accuracy compared to commercial boluses. The consistent bolus positioning minimized interfraction setup variations, leading to lower standard deviations in the measured doses. While this study did not directly quantify the air gap, prior research has reported air gap reductions of over 72% with patient-specific boluses. Conclusion: This case report supports the effectiveness of handmade boluses in combination with 6 MV photons for skin cancer RT, particularly in resource-constrained settings where advanced treatment modalities may not be readily available. The handmade bolus approach provides an accessible solution to enhance the precision of skin cancer RT.

Solid pseudopapillary neoplasms (SPNs) represent a tumor of the exocrine pancreas, belonging to the group of pancreatic cystic neoplasms. It is exceedingly uncommon for SPNs to manifest in extrapancreatic locations, such as the mesocolon, greater omentum, jejunum, and ovary. SPNs are considered very rare, constituting about 0.17%-2.5% of all pancreatic neoplasms and 6% of cystic pancreatic neoplasms. We present two pediatric cases of SPNs: one involving a 16-year-old female patient and the other a 14-year-old girl, both diagnosed and treated in our center with surgical resection. The experience of our center confirms that wide margin surgery, with associated metastasectomy if necessary, represents the therapy of choice for SPNs, ensuring effective control of the disease.

Background: Cardiac metastases, though more common than primary cardiac tumors, remain under-recognized due to their often subtle clinical presentation. These tumors can lead to life-threatening complications, and their diagnosis is typically delayed. Objective: This paper is aimed at reviewing two distinct cases of metastatic cardiac tumors, shedding light on diagnostic challenges, clinical presentations, and management approaches. Methods: We present two cases of patients with metastatic melanoma and undifferentiated malignant spindle cell neoplasm, respectively. Diagnostic imaging, including echocardiography and PET scans, was used to identify the cardiac masses, and biopsy results provided histopathological confirmation. Treatment plans involved systemic immunotherapy, chemotherapy, and surgical resection. Results: In both cases, cardiac metastases were detected through advanced imaging, despite the patients presenting with nonspecific symptoms like abdominal pain and shortness of breath. The metastatic tumor in one patient responded to immunotherapy before surgical excision, while the other patient, in advanced stages, opted for supportive care. Conclusion: Cardiac metastasis should be considered in cancer patients who present with unexplained cardiac symptoms. A multidisciplinary approach, including imaging and biopsy, is crucial for accurate diagnosis. Despite aggressive treatment, the prognosis remains poor, emphasizing the need for early detection and better therapeutic strategies.

Background: Pneumocystis jirovecii pneumonia (PJP) is a well-recognized opportunistic infection in immunocompromised patients, particularly those with hematological malignancies or HIV infection. However, its occurrence in patients with solid tumors undergoing chemotherapy remains poorly characterized. Case Presentation: We report the case of an 84-year-old male patient with HER2-positive breast cancer who developed severe PJP following adjuvant chemotherapy with paclitaxel and trastuzumab. The patient had no known immunosuppressive conditions and did not present chemotherapy-induced lymphopenia prior to the onset of symptoms. He was admitted with fever and dyspnea, 9 days after discontinuation of chemotherapy due to Grade 3 asthenia. Chest computed tomography (CT) revealed diffuse ground-glass opacities, and bronchoalveolar lavage confirmed the presence of Pneumocystis jirovecii DNA by PCR. Despite prompt initiation of sulfamethoxazole/trimethoprim and corticosteroids, the patient developed refractory acute respiratory distress syndrome (ARDS) and died after ICU admission. Discussion: This case highlights the potential risk of PJP in elderly patients receiving adjuvant chemotherapy, even in the absence of evident immunosuppression. Given the increasing use of chemotherapy in older populations, a thorough risk-benefit assessment should be considered, especially when the expected survival benefit is limited. Current guidelines do not recommend systematic PJP prophylaxis in patients with solid tumors, yet emerging evidence suggests that chemotherapy-related lymphopenia may increase susceptibility to opportunistic infections. Conclusion: Clinicians should maintain a high index of suspicion for opportunistic infections such as PJP in elderly patients undergoing chemotherapy, regardless of their immune status. This case underscores the importance of individualized risk stratification and vigilant monitoring to prevent and manage life-threatening complications.

Dermatofibrosarcoma protuberans (DFSP) is a rare soft tissue sarcoma originating from fibroblasts in the dermal connective tissue, comprising approximately 1% of all soft tissue sarcomas. While most cases involve the trunk and extremities, only 10%-15% occur in the cephalic region, representing less than 1% of all head and neck neoplasms. DFSP is notable for its high propensity for local recurrence following surgical excision and its low metastatic potential. We report a case of recurrent DFSP of the forehead extending to the anterior wall of the left frontal sinus, without brain involvement, in a 33-year-old male with a history of three prior wide local excisions. A multidisciplinary cancer team recommended systemic imatinib therapy. This case highlights the challenges of managing DFSP in an uncommon location, underscoring the importance of a multidisciplinary approach in addressing recurrent and complex presentations.

Primary mediastinal large B-cell lymphoma (PMBCL) is a highly aggressive malignancy primarily observed in female patients during their third decade of life. This rare condition, with an incidence of 0.4 per million, traditionally presents with B symptoms or compressive-based sequela such as SVC syndrome or respiratory distress. In this report, we present the case of a young female who presented for palpitations and tachycardia without cardiopulmonary compressive-based symptoms diagnosed with a large 16-cm infiltrative PMBCL localized in the left ventricle.