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Respiratory Medicine Case Reports 2023Immune checkpoint inhibitors became the treatment of choice, in monotherapy or in association with platinum-based doublet chemotherapy, in first-line therapy for...
Immune checkpoint inhibitors became the treatment of choice, in monotherapy or in association with platinum-based doublet chemotherapy, in first-line therapy for advanced-stage non-small-cell lung cancer without oncogenic driver. Nevertheless, it can be associated with diverse immune-related adverse events; several immune-related adverse events can also follow each other involving multiple organ systems, leading to immune checkpoint inhibitors discontinuation and immunosuppressive therapy that could compromise the prognosis of patients, with the exception of rare situations such as this clinical case. This case report illustrates a succession of immune-related adverse events including a rare and severe pembrolizumab-induced immune-related encephalitis in a patient with metastatic lung adeno-squamous carcinoma in whom we could observe a long-term and complete remission despite discontinuation of treatment and high-dose corticosteroids. In metastatic non-small-cell lung cancer, a disease with a poor initial prognosis, some patients can benefit from immune checkpoint inhibitors and can even now present a long-term and complete remission and this despite severe and rare immune-related adverse events, high-dose corticosteroids and an early discontinuation of treatment.
PubMed: 37577125
DOI: 10.1016/j.rmcr.2023.101898 -
Breast (Edinburgh, Scotland) Oct 2023Adenosquamous proliferation (ASP) is known to occur in the central nidus of radial sclerosing lesions (RSL) of the breast. However, their significance is debated and...
Adenosquamous proliferation (ASP) is known to occur in the central nidus of radial sclerosing lesions (RSL) of the breast. However, their significance is debated and remains largely unknown. In addition, there is a histologic overlap between ASP and low-grade adenosquamous carcinomas (LGASC). We conducted a large retrospective review of 247 RSLs to evaluate the prevalence of ASP and quantitatively analyze associated histologic features of RSLs including size, stromal cellularity, and presence of chronic inflammation. The central nidus of RSLs were classified as hyalinized in 121 cases (49%), cellular in 37 cases (15%), and equally mixed hyalinized and cellular in 89 (36%). ASP occurred in 92 of 247 RSLs (37.2%). Cases with ASP were significantly associated with a cellular stroma; 78.4% of RSLS with cellular stroma had ASP versus just 11.6% of hyalinized RSLs. In our large cohort, inflammation is commonly found in RSLs with ASP (p= <0.001). In conclusion, we confirm that ASP is statistically more likely to be found in RSLs with a cellular stroma. In addition, ASP is commonly associated with chronic inflammation. The finding challenges the notion that prominent lymphocytes are a diagnostic clue to LGASC on limited biopsy material.
Topics: Female; Humans; Breast Neoplasms; Breast; Fibrocystic Breast Disease; Carcinoma, Adenosquamous; Inflammation; Cell Proliferation
PubMed: 37566996
DOI: 10.1016/j.breast.2023.08.002 -
ACG Case Reports Journal Aug 2023Squamous cell carcinoma of the biliary tract is a rare disease, comprising just 2% of all biliary malignancies. The exact etiology is poorly understood but believed to...
Squamous cell carcinoma of the biliary tract is a rare disease, comprising just 2% of all biliary malignancies. The exact etiology is poorly understood but believed to be secondary to chronic inflammation. We present a case of a patient with recurrent cholecystitis and cholangitis who developed invasive biliary squamous cell carcinoma.
PubMed: 37547480
DOI: 10.14309/crj.0000000000001119 -
Thoracic Cancer Sep 2023A patient presented with vomiting and gait disturbance. Investigation revealed a single cerebellar tumor and another tumor in the upper lobe of the left lung. Based on...
A patient presented with vomiting and gait disturbance. Investigation revealed a single cerebellar tumor and another tumor in the upper lobe of the left lung. Based on the severe vomiting and gait disturbance, we removed the cerebellar tumor first, achieving resolution of symptoms. The cerebellar tumor was pathologically diagnosed as metastatic lung adenocarcinoma. No other metastases were identified, including in the mediastinal lymph nodes. We therefore resected the primary lung tumor. On final pathological analysis, the tumor in the upper lobe of the left lung was diagnosed as adenosquamous carcinoma with no lymph node metastasis. PD-L1 expression was low in the primary lung adenosquamous carcinoma and high in the cerebellar metastasis. Furthermore, both tumors were KRAS -positive. Tumor PD-L1 expression is considered important for immune escape. In this case, adenocarcinoma cells in the primary adenosquamous carcinoma may have migrated to form a cerebellar metastasis. In advanced lung cancer, tumor growth may be observed in some lesions even when many other lesions are controlled by chemo- or immunotherapy. Biopsy to confirm histology and PD-L1 expression is worth considering, depending on the location of the metastases and the invasiveness of the biopsy procedure.
Topics: Humans; B7-H1 Antigen; Carcinoma, Adenosquamous; Cerebellar Neoplasms; Lung; Lung Neoplasms; Brain Neoplasms; Biomarkers, Tumor
PubMed: 37545057
DOI: 10.1111/1759-7714.15061 -
Journal of Cancer Metastasis and... 2023Pancreatic cancer is an aggressive malignancy with increasing incidence. Pancreatic ductal adenocarcinoma (PDAC) accounts for > 90% of pancreatic cancer diagnoses, while...
Pancreatic cancer is an aggressive malignancy with increasing incidence. Pancreatic ductal adenocarcinoma (PDAC) accounts for > 90% of pancreatic cancer diagnoses, while other exocrine tumors are much rarer. In this review, we have focused on two rare cancers of the exocrine pancreas: adenosquamous carcinoma of the pancreas (ASCP) and pancreatic acinar cell carcinoma (PACC). The latest findings regarding their cellular and molecular pathology, clinical characteristics, prognosis, and clinical management are discussed. New genetic and transcriptomic data suggest that ASCP is related to or overlaps with the basal transcriptomic subtype of PDAC. These tumors are highly aggressive and driven by activated and expression. Clinical outcomes remain poor and effective treatments are limited. PACC has no morphologic or genetic resemblance to PDAC and more favorable outcomes. Early stage PACC patients have improved survival with surgical resection and patients with advanced disease benefit most from platinum- or fluoropyrimidine-containing chemotherapy. Frequency of actionable genetic mutations is high in this disease and case reports suggest good outcomes when matched therapy is given. Dedicated clinical studies examining ASCP and PACC are limited and difficult to accrue. Further research is needed to define optimal clinical management for these rare diseases.
PubMed: 37538977
DOI: 10.20517/2394-4722.2022.106 -
Cureus Jun 2023This case report describes an unusual paraneoplastic leukemoid response presenting in a rare instance of gallbladder (GB) adenosquamous carcinoma (ASC). Adenocarcinoma...
This case report describes an unusual paraneoplastic leukemoid response presenting in a rare instance of gallbladder (GB) adenosquamous carcinoma (ASC). Adenocarcinoma is the most prevalent histological subtype of GB carcinoma, which is most frequently diagnosed in people in their sixth and seventh decades of life. Adenosquamous and squamous variations are uncommon. Rarely have reports of paraneoplastic leukemoid reaction (PLR) in GB carcinoma been made; this reaction is characterized by a white cell count exceeding 50,000/mm in combination with solid malignancy. PLR has most commonly been found in association with lung carcinoma. In this instance, a 40-year-old man presented with right upper abdominal pain and a total leukocyte count of 26 x 10/L. The patient was initially treated on the lines of acute cholecystitis. But when the abdominal symptoms and leukocytosis did not settle, open cholecystectomy was performed. The results of the histopathological analysis showed that the GB had adenosquamous cancer. The white cell count increased even after surgery. Leukocytosis in the patient was looked into further to rule out hematological malignancy and other possible reasons. Sadly, the patient expired before any treatment could be started. The cancer GB carcinoma is uncommon and aggressive. Despite its rarity, ASC should be included in the differential diagnosis. PLR is an unusual manifestation associated with GB carcinoma. A thorough investigation, including a complete blood count, can help identify this paraneoplastic syndrome in patients with elevated white cell counts.
PubMed: 37519607
DOI: 10.7759/cureus.41040 -
Acta Otorhinolaryngologica Italica :... Oct 2023Head and neck adenosquamous cell carcinoma (HN-ASCC) is a rare, aggressive neoplasm, with limited data reported in the literature. The aim of this study was to assess...
OBJECTIVES
Head and neck adenosquamous cell carcinoma (HN-ASCC) is a rare, aggressive neoplasm, with limited data reported in the literature. The aim of this study was to assess tumour behaviour and prognostic factors impacting overall survival (OS) in a retrospective, single institution series.
METHODS
A retrospective study on patients affected by HN-ASCC who were treated surgically between 2002 and 2019 at the Department of Otorhinolaryngology - Head and Neck Surgery of the University of Brescia was conducted. Demographics, clinical data, OS, and relative prognostic factors were analysed.
RESULTS
The study included 32 patients, with a median age of 66 years, mostly males (84.4%) and untreated (68.8%). Adjuvant treatments followed surgery in 28.1% of patients. Compared to conventional SCC, ASCC showed a higher proportion of cases arising in the larynx (40.6%); no difference was found in other features. Advanced (pT3-4) local stage at presentation (p = 0.023), perineural invasion (PNI, p = 0.01), and positive margins (p = 0.007) were independent negative prognostic factors for OS.
CONCLUSIONS
HN-ASCC is a rare, aggressive cancer, most frequently arising in the larynx of elderly males, usually diagnosed in an advanced local stage. OS is generally poor, affected by local advanced stage, PNI, and positive resection margins.
PubMed: 37519139
DOI: 10.14639/0392-100X-N2466 -
Thoracic Cancer Sep 2023
PubMed: 37518989
DOI: 10.1111/1759-7714.15048 -
Journal of Cancer Research and... 2023Lung cancer is among the most frequently diagnosed cancers and the world's leading cause of cancer-related death. Radiology remains the mainstay for timely diagnosis;...
Lung cancer is among the most frequently diagnosed cancers and the world's leading cause of cancer-related death. Radiology remains the mainstay for timely diagnosis; however, atypical radiologic patterns are known, and these may be misdiagnosed as infectious or inflammatory pathology, particularly in the absence of smoking history. We report herein an account of an older male nonsmoker who presented radiologically with bilateral diffuse pulmonary infiltrates, simulating pneumonia, but was eventually diagnosed with adenosquamous lung carcinoma. The delay in diagnosis and subsequent unfortunate rapid deterioration of our patient serves as a reminder for clinicians to consider lung cancer in patients with clinical/radiologic findings suggestive of pneumonia, especially in nonsmokers or cases refractory to antibiotic therapy.
Topics: Humans; Male; Carcinoma, Adenosquamous; Lung; Pneumonia; Lung Neoplasms; Radiography
PubMed: 37470624
DOI: 10.4103/jcrt.jcrt_2174_21 -
Annals of Medicine and Surgery (2012) Jun 2023Ampullary carcinomas are uncommon malignant tumours of the digestive system, they usually are adenocarcinomas presenting histologically as three types: intestinal,...
UNLABELLED
Ampullary carcinomas are uncommon malignant tumours of the digestive system, they usually are adenocarcinomas presenting histologically as three types: intestinal, pancreaticobiliary and mixed. β-catenin is a multifunctional protein involved in physiological homoeostasis and intracellular adhesion. Abnormal nuclear accumulation of β-catenin has been described in many malignancies such as colon, breast, liver and others. The relationships between the immunohistochemical expression of β-catenin and the subtype, the grade and the stage of ampullary carcinoma are studied.
MATERIAL AND METHODS
A cross-sectional retrospective study was done on 25 formalin-fixed paraffin-embedded blocks of ampullary carcinoma: Cases were collected from the archives of the pathology department in the Gastroenterology and hepatology teaching hospital, medical city/ Baghdad from January 2019 to March 2022. The data of the patients and the characteristics of the tumour were derived from the pathological reports; additional sections from the block were stained with β-catenin immunohistochemically.
RESULTS
25 paraffin blocks from patients with ampullary carcinoma (12 males, 13 females) were included in the study. 64% of the cases are classified as pancreaticobiliary, 20% as mixed, 12% as intestinal and 4% as adenosquamous type. Eighty-four percent of the cases are moderately differentiated, and the remaining is poorly differentiated. Most cases show strong β-catenin membranous staining and 80% express 3+ staining of cytoplasmic β-catenin. Regarding nuclear β-catenin staining, 56% has negative staining.
CONCLUSION
No significant association was found between the cytoplasmic and the nuclear expression of β-catenin and the tumour type, size and lymph node status. The grade of the tumour showed a significant correlation with the cytoplasmic expression; while, no correlation was noted with the nuclear expression. This study results do not support the use of beta-catenin as a diagnostic marker or prognostic marker in ampullary cancers.
PubMed: 37363570
DOI: 10.1097/MS9.0000000000000750