Case Reports in Oncology

Publications in this journal

• Article: Systemic Mastocytosis Presenting as Acute Appendicitis: A Case Report and Review of the Literature

  Akbar S.A.a · Raza S.b · Denney J.E.c · Johannesen E.J.c · Doll D.C
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  ABSTRACT: Systemic mastocytosis is characterized by abnormal growth and accumulation of mast cells in various organs. Gastrointestinal (GI) symptoms are common disease manifestations in this disease and can significantly impair the quality of life. Signs of GI systemic mastocytosis include steatorrhea, malabsorption, hepatomegaly, splenomegaly, portal hypertension, and ascites. Acute appendicitis as a presenting feature in systemic mastocytosis has not been reported in the literature previously. In this report, we discuss the case of a female patient with systemic mastocytosis (c-KIT D816V (+)) who was admitted for right-sided acute abdominal pain. Laboratory study revealed an normal white blood cell count with eosinophilia and an elevated serum tryptase level of 23 μg/l. CT of the abdomen and pelvis showed an enlarged appendix of 12 mm in diameter, with minimal wall enhancement. Laparoscopic appendectomy was performed. The appendix was found to be hyperemic and firm, and it was densely adherent to the posterior cecum, the surrounding peritoneal wall, and the overlying mesenteric fat. Pathology revealed acute appendicitis with greater than 30 mast cells per high-power field by immunoperoxidase studies with mast cell tryptase and CD117. The patient subsequently improved and was discharged home. This case is the first reported case with a histological diagnosis of acute appendicitis resulting from mast cell infiltration. Physicians should be aware of acute appendicitis as a manifestation of systemic mastocytosis. Prompt diagnosis and management may prevent potentially fatal complications of appendiceal perforation and peritonitis.
  Case Reports in Oncology 03/2013; 6(1):174-179.
• Article: Tuberculous and non-tuberculous granulomatous lymphadenitis in patients receiving imatinib mesylate (glivec) for metastatic gastrointestinal stromal tumor.

  Abbas Agaimy, Valeska Brueckl, Daniela Schmidt, Stephanie Krieg, Evelyn Ullrich, Norbert Meidenbauer
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  ABSTRACT: Imatinib mesylate (IM) is the standard treatment for BCR-ABL-positive chronic myelogenous leukemia (CML) and is the first-line adjuvant and palliative treatment for metastatic and inoperable gastrointestinal stromal tumor (GIST). IM is not known to be associated with an increased risk for development of granulomatous diseases. We describe our experience with 2 patients (42 and 62 years of age) who developed granulomatous disease during IM treatment for metastatic GIST. Mean duration of IM treatment was 12 (range 8-16) months. Enlarged lymph nodes with increased metabolism on FDG-PET-CT examination were detected and resected. Affected sites were supraclavicular (1) and subcarinal/mediastinal (1) lymph nodes. Histological examination revealed caseating and non-caseating granulomas suggestive of tuberculosis and sarcoidosis, respectively. Mycobacterium tuberculosis was detected by PCR in lymph nodes of 1 patient who was then successfully treated by anti-tuberculous agents. The other patient had negative sputum test for acid-fast bacilli and PCR-DNA-analysis was negative for M. tuberculosis and other mycobacteria. He received no anti-tuberculous therapy and had no evidence of progressive lymphadenopathy or new lung lesions during follow-up. Our observations underline the necessity to obtain biopsy material from enlarged or metabolically active lymph nodes developing during IM treatment for timely diagnosis and appropriate treatment of these rare complications. Follow-up without treatment is safe for patients without detectable microorganisms by sputum examination and PCR.
  Case Reports in Oncology 01/2013; 6(1):134-42.
• Article: Burkitt's Lymphoma Presenting as Late-Onset Posttransplant Lymphoproliferative Disorder following Kidney and Pancreas Transplantation: Case Report and Review of the Literature.

  Seema Naik, Kristy Tayapongsak, Katherine Robbins, Cyrus Koresh Manavi, Mark J Pettenati, David D Grier
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  ABSTRACT: Posttransplant lymphoproliferative disorders (PTLD) are a rare, but serious complication following transplantation. Late-onset PTLD are often associated with more monoclonal lesions and consequently have a worse prognosis. There are only isolated case reports of Burkitt's lymphoma presenting as PTLD. We present an extremely rare, aggressive Burkitt's lymphoma years after kidney and pancreas transplantation which was successfully treated with combination chemotherapy along with withdrawal of immunosuppression. The patient remains in complete remission more than 2 years after his diagnosis. We also provide a succinct review of treatment of various PTLD and discuss the role of Epstein-Barr virus infection in the pathogenesis of PTLD.
  Case Reports in Oncology 01/2013; 6(1):6-14.
• Article: High-Grade Serous Tumor Arising from Fallopian Tube in a BRCA Mutation Carrier after Prophylactic Oophorectomy.

  Domenica Lorusso, Roberta Di Rocco, Maria Mancini, Francesco Raspagliesi
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  ABSTRACT: We present the case of a 67-year-old patient with a BRCA1 mutation and breast cancer who underwent prophylactic oophorectomy. After 6 years, an abdominal computed tomography revealed a pelvic mass which proved to be a poorly differentiated serous carcinoma originating from the right residual tube which previously had not been removed during prophylactic surgery. This case report suggests that much effort should be made during prophylactic oophorectomy to completely remove the tubes, especially in light of the recent pathologic theories on the tubal origin of ovarian cancer.
  Case Reports in Oncology 01/2013; 6(1):21-4.
• Article: Proton beam therapy and continuous intra-arterial chemotherapy for polymorphous low-grade adenocarcinoma in the hard palate.

  Chiyoko Makita, Tatsuya Nakamura, Kanako Takayama, Akinori Takada, Nobukazu Fuwa, Hideo Sakuma
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  ABSTRACT: Polymorphous low-grade adenocarcinoma is a rare malignant tumor that mainly occurs in salivary glands, particularly in the hard palate. To date, surgery has been the most commonly used treatment method with the aim of achieving negative margins of resection. Here, we report a case of a 51-year-old woman who presented with a painless growing mass in her oral cavity with Rouviere's lymph node metastasis. Laboratory data showed severe anemia because of bleeding from the tumor. We inserted two catheters into the bilateral external carotid arteries via the superficial temporal arteries, and began continuous intra-arterial infusion with cisplatin and a cisplatin-neutralizing agent. The bleeding stopped after the first infusion, and we continued with weekly arterial cisplatin infusion and proton beam therapy (70.4 GyE in 32 fractions). A decrease in tumor volume has been maintained for 2 years, with no evidence of new metastasis.
  Case Reports in Oncology 01/2013; 6(1):66-71.
• Article: Response of meningeal carcinomatosis from breast cancer to capecitabine monotherapy: a case report.

  Yumi Tanaka, Shoji Oura, Tatsuya Yoshimasu, Fuminori Ohta, Koma Naito, Rie Nakamura, Yoshimitsu Hirai, Masako Ikeda, Yoshitaka Okamura
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  ABSTRACT: A 62-year-old woman with breast cancer received neoadjuvant chemotherapy followed by breast-conserving surgery and sentinel node biopsy. During adjuvant endocrine therapy with aromatase inhibitor, she developed multiple bone metastases. Thereafter, she received tamoxifen and zoledronate therapy. In May 2011, she developed a tongue deviation and was diagnosed as having meningeal carcinomatosis. The tongue deviation disappeared 3 weeks after taking capecitabine (2,400 mg/day). Magnetic resonance imaging of the brain showed regression of meningeal carcinomatosis. Levels of tumor markers CEA and CA15-3 changed from 96.0 IU/ml and 3.5 ng/ml to 47.0 IU/ml and 1.5 ng/ml, respectively. Progression-free survival with capecitabine monotherapy was 5 months.
  Case Reports in Oncology 01/2013; 6(1):1-5.
• Article: Diagnosis and management of primary umbilical melanoma with omphalitis features.

  Y Song, D Xu, L Sun, K Ding, Y Hu, Y Yuan
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  ABSTRACT: We report on a 62-year-old Chinese male patient who presented with a pigmented lesion in the umbilical area and who was treated for omphalitis in a local hospital for 1 month. Biopsy pathological examination revealed that the lesion was a melanoma. The Breslow depth was estimated at 3 mm, and Clark's level was IV. Ultrasonography showed no suspicious pathological lymph nodes, and no metastases were detected in the lung, liver or brain through CT scans. Reexcision was performed with lateral marginsd >2 cm from the original scar down to the peritoneum, including the umbilicus, round ligament of the liver and urachus. No adjuvant therapy was suggested, and the patient was still alive without recurrences or metastases after 36 months.
  Case Reports in Oncology 01/2013; 6(1):154-7.
• Article: Adenocarcinoma in colonic interposition.

  Shahar Grunner, Hayim Gilshtein, Eliahu Kakiashvili, Yoram Kluger
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  ABSTRACT: A 59-year-old female with dysphagia presented to our clinic. In childhood, she underwent colonic interposition due to anastomotic stricture after a previous proximal gastrectomy for gastric ulcer perforation. Imaging studies revealed a space-occupying lesion obstructing the distal interposed colon. At surgery, completion gastrectomy with segmental colectomy was carried out, and Roux-en-Y coloenterostomy and enteroenterostomy were performed.
  Case Reports in Oncology 01/2013; 6(1):186-8.
• Article: Spontaneous Regression of Hepatocellular Carcinoma due to Disruption of the Feeding Artery.

  Akihiro Okano, Masaya Ohana, Fusako Kusumi, Motoshige Nabeshima
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  ABSTRACT: We present an unusual case of spontaneous regression of hepatocellular carcinoma (HCC). A 77-year-old man with alcoholic liver cirrhosis presented with a 50-mm tumor in the Couinaud's segment 8 (S8) of the liver, a 15-mm tumor in the S8-7 and 10-mm tumors in the other segments (S4, S6). The tumors were diagnosed as HCC by typical imaging findings and elevated serum alpha-fetoprotein (AFP, 1,825.0 ng/ml) and protein induced by vitamin K absence II (PIVKA II, 3,043 mAU/ml). One month later, AFP and PIVKA II decreased to 51.1 ng/ml and 411 mAU/ml, respectively, and the 50-mm tumor in the S8 became small and completely necrotic on angiography and computed tomography arteriography without any treatment. On the other hand, the 15-mm tumor in the S8-7 decreased in size to 10 mm and received blood supply from the right posterior superior arteries (A7). The other 10-mm tumors remained. Ischemia of the tumors due to disruption of the feeding artery (A8) might have induced tumor regression in the present case.
  Case Reports in Oncology 01/2013; 6(1):180-5.
• Article: Gastrointestinal stromal tumor: a rare abdominal tumor.

  Shagufta Shaheen, Achuta K Guddati
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  ABSTRACT: Gastrointestinal stromal tumors (GISTs) are rare abdominal tumors which arise from the interstitial cells of Cajal in the gastrointestinal tract. Gastric GISTs are the most commonly seen GIST tumors and may grow to a very large size. They are often associated with abdominal pain, anorexia and weight loss. Most of them can be detected by CT. These tumors have been found to harbor mutations in CD117 which causes constitutional activation of the tyrosine kinase signaling pathway and is considered to be pathognomic. Tyrosine kinase inhibitors such as imatinib have revolutionized the treatment of these tumors, which are otherwise resistant to conventional chemotherapy and radiotherapy. Although surgical resection is the mainstay of treatment, tyrosine kinase inhibitors have been useful in prolonging the recurrence-free survival of these patients. Resistance to imatinib has been reported in GISTs with specific mutations. We present a case of gastric GIST which grew to a very large size and was associated with abdominal pain and weight loss. It was successfully resected and the patient was commenced on imatinib therapy.
  Case Reports in Oncology 01/2013; 6(1):148-53.
• Article: Dystonia in a patient with melanoma metastatic to the brain treated with high-dose interleukin-2, radiation therapy, and levetiracetam.

  Varun Sreenivasan, Arkadiusz Z Dudek
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  ABSTRACT: Dystonia has been described as a potential toxicity of radiation therapy. Management of this rare movement disorder is targeted in symptom improvement. We report a case of a 46-year-old female patient who developed dystonia during treatment of melanoma metastatic to the brain and discuss potential causes of and therapies for this rare complication.
  Case Reports in Oncology 01/2013; 6(1):78-83.
• Article: Solitary schwannoma of the cecum: case report and review of the literature.

  José Wilson Benevides de Mesquita Neto, Renato Mazon Lima Verde Leal, Eurivaldo Valente de Brito, Diego Fonseca Cordeiro, Marcelo Leite Vieira Costa
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  ABSTRACT: A 78-year-old woman presented with an abdominal mass diagnosed by ultrasound and computed tomography. The patient underwent a laparotomy, during which a retroperitoneal tumor adherent to the cecum wall was identified. Microscopically, it showed spindle-cell proliferation in whorls, with low mitotic count (2 per 50 high-power fields) and was strongly positive for S-100 protein and vimentin. The final diagnosis was benign schwannoma of the cecum and no further treatment was required. Large intestine schwannomas are extremely rare tumors and only a few cases of schwannoma of the cecum have been reported to date.
  Case Reports in Oncology 01/2013; 6(1):62-5.
• Article: Detection of EGFR T790M Mutation in Pericardial Effusion from a Non-Small Cell Lung Cancer Patient with Erlotinib Therapy.

  Asao Sakai, Kazuo Kasahara, Takashi Sone
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  ABSTRACT: We report the case of a Japanese male with epidermal growth factor receptor tyrosine kinase inhibitor (EGFR-TKI)-sensitive lung adenocarcinoma, who had an EGFR mutation and presented in the emergency department with acute cardiac tamponade as the recurrence during EGFR-TKI therapy. We could detect a second mutation, T790M in exon 20 in the pericardial effusion. This is the first report to detect the resistant mutation T790M in pericardial effusion. We suggest that the pericardial effusion may therefore be useful as surrogate tissue for detecting EGFR mutation.
  Case Reports in Oncology 01/2013; 6(1):15-20.
• Article: Metachronous gastrointestinal stromal tumor and acute leukemia after liver transplantation for cholangiocellular carcinoma: is there a link?

  Anna Mrzljak, Iva Košuta, Anita Skrtićl, Ika Kardum-Skelin, Radovan Vrhovac
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  ABSTRACT: The synchronous or metachronous coexistence of gastrointestinal stromal tumors (GISTs) with solid and hematologic neoplasms has been addressed in a non-transplant population. However, the association with primary hepatic neoplasms and leukemias is uncommon. Scarce data exist considering association of GISTs and other neoplasms in a transplant population where long-term immunosuppression carries the additional burden of de novo malignancy. We present a case of posttransplant metachronous GIST and acute biphenotypic leukemia in a patient transplanted for intrahepatic cholangiocellular carcinoma, emphasizing the possible link between mechanisms of carcinogenesis and influence of other factors upon their development.
  Case Reports in Oncology 01/2013; 6(1):163-8.
• Article: Targeting VEGF-VEGFR Pathway by Sunitinib in Peripheral Primitive Neuroectodermal Tumor, Paraganglioma and Epithelioid Hemangioendothelioma: Three Case Reports.

  Tiziana Prochilo, Giordano Savelli, Paola Bertocchi, Chiara Abeni, Luigina Rota, Anna Rizzi, Alberto Zaniboni
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  ABSTRACT: Sunitinib malate (Sutent(TM); Pfizer Inc., New York, N.Y., USA) is a small molecule kinase inhibitor with activity against a number of tyrosine kinase receptors, including vascular endothelial growth factor receptors, stem-cell factor receptor, and platelet-derived growth factor receptors alpha and beta. Sunitinib, registered for the treatment of renal cell carcinoma and gastrointestinal stromal tumors, has recently been approved for the treatment of patients with advanced pancreatic neuroendocrine tumors. Peripheral primitive neuroectodermal tumor (pPNET), paraganglioma (PGL) and epithelioid hemangioendothelioma (EHE) are rare tumors in which there is an overexpression of pro-angiogenic factors and in which a high intratumoral microvessel density is a significant poor prognostic factor. On the basis of this preclinical rationale and the lack of effective treatments in pre-treated advanced stages of these rare diseases, we report our interesting experience of pPNET, PGL and EHE treatment with sunitinib.
  Case Reports in Oncology 01/2013; 6(1):90-7.
• Article: Posterior reversible leukoencephalopathy syndrome associated with pazopanib.

  Robert Foerster, Thomas Welzel, Juergen Debus, Carsten Gruellich, Dirk Jaeger, Karin Potthoff
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  ABSTRACT: A 62-year-old female patient with metastatic renal cell carcinoma under third-line treatment with pazopanib for 8 weeks suddenly developed severe headaches, grand mal seizures and paresis of the left arm in combination with gait instability as well as nausea and vomiting during her vacation abroad. The emergency physician measured systolic blood pressure values over 300 mm Hg and suspected a stroke. The CT imaging without contrast agent in a local hospital did not show any pathologic findings despite bone metastases. The colleagues suspected cerebral metastases or meningeosis carcinomatosa and referred the patient to our department for further diagnostics and treatment planning. An MRI scan ruled out the suspected cerebral metastases or meningeosis carcinomatosa, but showed signs of reversible posterior leukoencephalopathy syndrome (RPLS) in the form of band-like hyperintensities as a sign of cytotoxic edema in the gray and white matter of the left parietal lobe. The patient then reported that similar blood pressure values had been measured shortly after the start of a first-line therapy with sunitinib, so that we discontinued the current treatment with pazopanib. Within 6 days the neurologic symptoms vanished and the patient was discharged. An intermittent hypertension persisted. A follow-up MRI 3 weeks later showed an RPLS-typical cortical infarction in the affected area. RPLS should be considered as the actual reason for neurologic findings in hypertensive patients with known metastatic cancers under tyrosine kinase inhibitor therapy.
  Case Reports in Oncology 01/2013; 6(1):204-8.
• Article: Endometrioid endometrial carcinoma indirectly caused by pituitary prolactinoma: a case report.

  Kimihiro Nishino, Yuri Niwa, Teruyuki Mizutani, Ken Shimizu, Kazumasa Hayashi, Jyunya Chaya, Noriko Kato, Osamu Yamamuro
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  ABSTRACT: We present the case of a 44-year-old nulliparous woman who experienced irregular menstrual cycles for about 10 years and developed both pituitary prolactinoma and endometrioid endometrial carcinoma. In premenopausal women, hyperprolactinemia causes hypogonadism by inhibiting secretion of gonadotropin-releasing hormone and thus suppressing luteinizing hormone levels, which can cause menstrual disorders ranging from amenorrhea, oligomenorrhea and chronic anovulatory cycle to short luteal phase of the menstrual cycle. A chronic anovulatory menstrual cycle is the most common cause of long-term exposure of the endometrium to endogenous estrogen without adequate opposition from progestins, which can lead to endometrioid endometrial carcinoma. In this case, pituitary prolactinoma may have caused the chronic anovulatory cycle and indirectly led to the endometrioid endometrial carcinoma. In patients for whom the cause of irregular menstruation and chronic anovulatory cycle is suspected to be hyperprolactinemia, explorations of both the hypophysis and endometrium are essential.
  Case Reports in Oncology 01/2013; 6(1):25-30.
• Article: Diverticular Bleeding of the Colon during Combination Chemotherapy with Bevacizumab and Paclitaxel for Recurrent Breast Cancer.

  Yoshie Nakayama, Yoshinori Ito, Masahiko Tanabe, Shunji Takahashi
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  ABSTRACT: Bevacizumab has been increasingly used in combination chemotherapy with paclitaxel for treatment of metastatic or recurrent breast cancer. The aim of this report is to underline possible risks associated with the new combination chemotherapy. A 39-year-old woman with recurrent breast cancer was treated with bevacizumab and paclitaxel. Positron emission tomography revealed breast cancer metastasis to the left supraclavicular lymph nodes and right axillary lymph nodes, with no distant metastasis. After the third cycle of bevacizumab and paclitaxel, the patient developed a bloody bowel discharge. Emergent colonoscopy demonstrated diverticular bleeding on one of the multiple diverticula in the ascending colon. The bleeding point was successfully clipped colonoscopically. The factors for diverticular bleeding are believed to be non-steroidal anti-inflammatory drugs, constipation, and bevacizumab. We recommend reviewing anamneses for diverticulitis, multiple prior abdominal surgeries, peritoneal carcinomatosis, and regular use of certain drugs.
  Case Reports in Oncology 01/2013; 6(1):50-4.
• Article: Clear cell sarcoma of the neck which metastasized to the mammary gland.

  Ippei Fukada, Seiichiro Nishimura, Masahiko Tanabe, Hidetomo Morizono, Masujiro Makita, Naoya Gomi, Rie Horii, Futoshi Akiyama, Takuji Iwase
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  ABSTRACT: Malignant neoplasms very rarely metastasize to the mammary gland, the incidence of which is reported as 0.5-2%. Clear cell sarcoma is a rare neoplasm, accounting for approximately 1% of all soft tissue tumors, which commonly occurs in the distal extremities of young adults aged approximately 20 to 40 years. So it is also called malignant melanoma of soft parts because it frequently produces melanin. We report a case of a 26-year-old woman who presented with a neck mass. The mass was surgically removed, and pathological diagnosis was clear cell sarcoma of the neck, harboring the chimeric gene. Computed tomography detected a right breast mass 11 months after operation. She was referred to our department, and the right breast tumor was resected. Histopathological examination revealed a 2.5-cm, well-defined mass composed of nests of small, spindle-shaped tumor cells with abundant, clear cytoplasm containing round nuclei and prominent nucleoli. The tumor cells were immunohistochemically positive for HMB45, S-100, and Melan-A. These findings led to a diagnosis of metastasis of clear cell sarcoma to the mammary gland. This is the first report of clear cell sarcoma of the neck which metastasized to the mammary gland.
  Case Reports in Oncology 01/2013; 6(1):55-61.
• Article: Uterine leiomyosarcoma manifesting as a tricuspid valve mass.

  Creticus P Marak, Ana M Ponea, Narendrakumar Alappan, Shagufta Shaheen, Achuta K Guddati
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  ABSTRACT: Uterine leiomyosarcoma is a rare malignancy and carries a poorer prognosis when compared to endometrial carcinoma. It has been observed to metastasize to all the major organs. It presents with symptoms of abdominal distension, vaginal bleeding and may pass unnoticed until an advanced stage in patients with leiomyomas. Surgery is a viable option in patients with disease limited to the uterus, but metastasis to the heart may require surgery to prevent acute and catastrophic complications. The case described here involves metastasis to the tricuspid valve, which caused severe tricuspid regurgitation in the setting of acute pulmonary embolism. Surgical resection restored cardiac function and stabilized the patient. This case illustrates a rare site of metastasis of leiomyosarcoma which required immediate intervention and resulted in a favorable outcome.
  Case Reports in Oncology 01/2013; 6(1):119-26.