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Vitiello F, Cereda S, Foti S, Liscia N, Mazza E, Ronzoni M, Cascinu S. Immunotherapy in small bowel adenocarcinoma: a potential role? Immunol Med 2024; 47:1-5. [PMID: 37293784 DOI: 10.1080/25785826.2023.2220938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 05/30/2023] [Indexed: 06/10/2023] Open
Abstract
Small bowel adenocarcinoma (SBA) is a rare tumor with an unfavorable prognosis, and due to its rarity, few studies on its treatment are available. Chemotherapy remains the standard of treatment in advanced disease. Recently immunotherapy has demonstrated to be a valid therapeutic option for many solid tumors. We reviewed the data published in literature to understand the impact of immunotherapy in this cancer.
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Affiliation(s)
- Francesco Vitiello
- Department of Medical Oncology Ospedale San Raffaele, Vita-Salute University San Raffaele, Comprehensive Cancer Center, Milan, Italy
| | - Stefano Cereda
- Department of Medical Oncology Ospedale San Raffaele, Vita-Salute University San Raffaele, Comprehensive Cancer Center, Milan, Italy
| | - Silvia Foti
- Department of Medical Oncology Ospedale San Raffaele, Vita-Salute University San Raffaele, Comprehensive Cancer Center, Milan, Italy
| | - Nicole Liscia
- Department of Medical Oncology Ospedale San Raffaele, Vita-Salute University San Raffaele, Comprehensive Cancer Center, Milan, Italy
| | - Elena Mazza
- Department of Medical Oncology Ospedale San Raffaele, Vita-Salute University San Raffaele, Comprehensive Cancer Center, Milan, Italy
| | - Monica Ronzoni
- Department of Medical Oncology Ospedale San Raffaele, Vita-Salute University San Raffaele, Comprehensive Cancer Center, Milan, Italy
| | - Stefano Cascinu
- Department of Medical Oncology Ospedale San Raffaele, Vita-Salute University San Raffaele, Comprehensive Cancer Center, Milan, Italy
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2
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Worbe N, Damian L, Le Cam-Duchez V, Levesque H, Michel P, Quak E. Hemorrhagic disseminated intravascular coagulation after 177Lu-Dotatate in metastatic midgut neuroendocrine tumor: A case report. Medicine (Baltimore) 2021; 100:e27455. [PMID: 34622868 PMCID: PMC8500554 DOI: 10.1097/md.0000000000027455] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 09/20/2021] [Indexed: 01/05/2023] Open
Abstract
RATIONALE Peptide receptor radionuclide therapy with 177Lu-Dotatate represents a major breakthrough in the treatment of metastatic well differentiated neuroendocrine tumors. This treatment is generally well tolerated. Reported severe long-term hematological side effects are rare and include hematopoietic neoplasms and bone marrow failure. PATIENTS CONCERNS We describe the case of a patient presenting spontaneous bleeding and bruising occurring 6 weeks after the first administration of 177Lu-Dotatate. Blood tests showed anemia, thrombocytopenia, prolonged clotting times, profound fibrinolysis and low levels of coagulation factors II and V. There were no signs of tumor lysis syndrome. DIAGNOSES We made the diagnosis of acute disseminated intravascular coagulation. INTERVENTION Treatment consisted of multiple transfusions of fresh frozen plasma, fibrinogen and platelets, and corticosteroids. Acute disseminated intravascular coagulation (DIC) persisted for 10 days and then resolved. OUTCOMES Metabolic imaging 5 months after the 177Lu-Dotatate administration showed disease progression. Treatment with 177Lu-Dotatate was not rechallenged due to the occurrence of DIC. LESSONS Our case suggests that acute hemorrhagic disseminated intravascular coagulation can be a rare and life-threatening subacute side effect of 177Lu-Dotatate peptide receptor radionuclide therapy.
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Affiliation(s)
- Noémie Worbe
- Rouen University Hospital, Department of Internal Medicine, Rouen, France
| | - Louise Damian
- Rouen University Hospital, Department of Internal Medicine, Rouen, France
| | - Véronique Le Cam-Duchez
- Normandie Univ, UNIROUEN, Inserm U1096, Rouen University Hospital, Hemostasis Unit, Rouen, France
| | - Hervé Levesque
- Rouen University Hospital, Department of Internal Medicine, Rouen, France
| | - Pierre Michel
- Rouen University Hospital, Department of Hepato-gastroenterology, Rouen, France
| | - Elske Quak
- UNICANCER, Comprehensive Cancer Centre F. Baclesse, Department of Nuclear Medicine, Caen, France
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3
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Sasaki Y, Kemuriyama K, Sasaki S, Orino K, Tozawa K, Hirano Y. [A Case of Malignant Lymphoma of the Ileum and Uterine Cervix with Perforating Peritonitis of Ileum Tumor Detected during Chemotherapy]. Gan To Kagaku Ryoho 2021; 48:1157-1159. [PMID: 34521795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
A 77-year-old woman was admitted to our hospital because of right lower abdominal pain. CT revealed tumors in the ileum and uterine cervix. After a gynecological biopsy of the uterine tumor, we diagnosed Stage Ⅳ diffuse large B-cell lymphoma. We treated her with R-THPCOP chemotherapy. On day 8 after the first chemotherapy, she developed perforated peritonitis, and an emergency partial ileum resection was performed. Histopathologically, viable cells were not found in the resected intestine. Chemotherapy was resumed on postoperative day 21, and she achieved a complete response 8 months after the surgery. Gastrointestinal malignant lymphoma is sometimes reported in cases requiring emergency surgery. Therefore, information sharing between hematologist and surgeon is recommended.
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Fernández JA, Ferreras D, Ruiz-Manzanera JJ, Olivares V, Ferri B, Frutos MD, Martínez J. Characteristics and prognosis of jejunoileal gastrointestinal stromal tumours (GISTs) in the era of imatinib: a comparative study with gastric GISTs. Clin Transl Oncol 2021; 23:1368-1376. [PMID: 33515420 DOI: 10.1007/s12094-020-02528-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 11/18/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Gastrointestinal stromal tumours (GISTs) located in the jejunum or ileum (JI-GIST) are considered worse prognosis compared to those of gastric (G-GIST) location. It has been suggested that this dogma should be revised. The aim of this study was to describe the characteristics of jejunoileal GISTs and its prognosis and to compare them with G-GISTs in the era of imatinib. METHODS We retrospectively reviewed the clinical histories of all the patients diagnosed with GISTs between January 2000 and November 2016: Clinical and pathological data, as recurrence, metastatic state, disease-free survival (DFS) as well as overall survival (OS) rates of patients were reviewed. RESULTS JI-GIST patients comprise 29 cases (37.7%). Compared to G-GIST, JI-GIST patients had undergone emergency surgery more frequently (37.9% vs. 10.4%, p = 0.007). According to the NIH-Fletcher classification, the low or very-low risk group represents 17.2% of JI-GISTs as opposed to 37.6% of G-GISTs (p < 0.005). When the AFIP-Miettinen system was used the low or very-low group represented 17.2% of JI-GISTs vs. 58.4% in the G-GISTs group (p < 0.001). Both local recurrence (24.1% vs. 12.5%, p < 0.05) and metastatic rate (34.5% vs. 22.9%, p < 0.05) were higher in the JI-GIST group than in G-GIST. 5- and 10-year DFS and 10-year OS rate were lower for JI-GIST (54.5% and 39.6% vs. 77.2% and 60.8%, and 57.9% vs. 65%, respectively, p < 0.05). CONCLUSIONS The observed differences between both groups in DFS and OS rates at long term could be attributed to the effect of imatinib.
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Affiliation(s)
- J A Fernández
- Digestive Surgery Department, Sarcoma Unit, "Virgen de La Arrixaca" University Hospital, Crta. Madrid Cartagena S/N, 30500, Murcia, Spain.
| | - D Ferreras
- Digestive Surgery Department, Sarcoma Unit, "Virgen de La Arrixaca" University Hospital, Crta. Madrid Cartagena S/N, 30500, Murcia, Spain
| | - J J Ruiz-Manzanera
- Digestive Surgery Department, Sarcoma Unit, "Virgen de La Arrixaca" University Hospital, Crta. Madrid Cartagena S/N, 30500, Murcia, Spain
| | - V Olivares
- Digestive Surgery Department, Sarcoma Unit, "Virgen de La Arrixaca" University Hospital, Crta. Madrid Cartagena S/N, 30500, Murcia, Spain
| | - B Ferri
- Pathology Department, "Virgen de La Arrixaca" University Hospital, Murcia, Spain
| | - M D Frutos
- Digestive Surgery Department, Sarcoma Unit, "Virgen de La Arrixaca" University Hospital, Crta. Madrid Cartagena S/N, 30500, Murcia, Spain
| | - J Martínez
- Oncology Department, "Virgen de La Arrixaca" University Hospital, Murcia, Spain
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Abstract
Small-bowel hemangiomas are a possible source of gastrointestinal bleeding for which there is no established treatment approach. In this report, we describe the case of a 58-year-old woman who presented with hematochezia and who was diagnosed with small bowel hemangioma. She was successfully treated using endoscopic sclerotherapy. Initial capsule endoscopy revealed bleeding in the ileum. Subsequent double-balloon enteroscopy showed a 2-cm, bluish-purple, ileal submucosal tumor with an overlying protrusion. The lesion was responsible for the hematochezia and was treated with intralesional injection of polidocanol. The hematochezia completely resolved and at 4 months after sclerotherapy, the size of the lesion was significantly reduced.
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Affiliation(s)
- Taiki Aoyama
- Department of Gastroenterology, Hiroshima City Asa Citizens Hospital, Japan
| | - Akira Fukumoto
- Department of Gastroenterology, Hiroshima City Asa Citizens Hospital, Japan
| | - Kenjiro Shigita
- Department of Gastroenterology, Hiroshima City Asa Citizens Hospital, Japan
| | - Naoki Asayama
- Department of Gastroenterology, Hiroshima City Asa Citizens Hospital, Japan
| | - Shinichi Mukai
- Department of Gastroenterology, Hiroshima City Asa Citizens Hospital, Japan
| | - Shinji Nagata
- Department of Gastroenterology, Hiroshima City Asa Citizens Hospital, Japan
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Özdirik B, Tacke F, Benz F, Amthauer H, Fehrenbach U, Roderburg C, Jann H. A case report of an excellent response to interferon- α in a patient with functional metastasized neuroendocrine tumor refractory to other treatments. Medicine (Baltimore) 2020; 99:e20820. [PMID: 32569231 PMCID: PMC7310897 DOI: 10.1097/md.0000000000020820] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 04/21/2020] [Accepted: 05/21/2020] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Interferon alpha (IFNα) has been used for a long time in patients with functionally active neuroendocrine tumors (NET). However, due to the unfavorable toxicity profile of interferon, the perceived limited efficacy as well as the development of novel substances, IFNα is only used sparingly in the treatment of NET to date. PATIENTS CONCERNS AND DIAGNOSIS We describe the case of a 63-year-old male patient with highly differentiated, functional NET of the ileum and synchronous liver metastasis. INTERVENTIONS After failure of classical therapies including dose-intensified somatostatin analog treatment and palliative primary tumor resection, a therapy with pegylated IFNα2a (135 μg/wk) was initiated. Following this treatment, the patient fully recovered from signs of hypersecretion and demonstrated an impressive tumor response. OUTCOMES Thirty months after initiating IFNα, the patient is still free of clinical symptoms and shows a sustained tumor response. Notably, no relevant side effects were observed. CONCLUSION Our case report supports the use of IFNα in patients with functional NET refractory to classical treatments.
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Affiliation(s)
- Burcin Özdirik
- Charité – University Medicine Berlin, Department of Hepatology and Gastroenterology, Campus Virchow Klinikum and Charité Campus Mitte
| | - Frank Tacke
- Charité – University Medicine Berlin, Department of Hepatology and Gastroenterology, Campus Virchow Klinikum and Charité Campus Mitte
| | - Fabian Benz
- Charité – University Medicine Berlin, Department of Hepatology and Gastroenterology, Campus Virchow Klinikum and Charité Campus Mitte
| | - Holger Amthauer
- Charité – University Medicine Berlin, Department of Nuclear Medicine, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Klinik für Nuklearmedizin
| | - Uli Fehrenbach
- Charité – University Medicine Berlin, Department of Radiology, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Klinik für Radiologie, Berlin, Germany
| | - Christoph Roderburg
- Charité – University Medicine Berlin, Department of Hepatology and Gastroenterology, Campus Virchow Klinikum and Charité Campus Mitte
| | - Henning Jann
- Charité – University Medicine Berlin, Department of Hepatology and Gastroenterology, Campus Virchow Klinikum and Charité Campus Mitte
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Mir O, Ropert S, Morice P, Berveiller P. Clinical Activity of Sunitinib and Regorafenib in Endometriosis. Mayo Clin Proc 2019; 94:2591-2593. [PMID: 31806110 DOI: 10.1016/j.mayocp.2019.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Accepted: 10/07/2019] [Indexed: 10/25/2022]
Affiliation(s)
- Olivier Mir
- Gustave Roussy Cancer Campus, Villejuif, France
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Murakami D, Matsuda K, Yokoyama S, Tamura K, Iwamoto H, Mizumoto Y, Deguchi M, Nakamura Y, Yamaue H. [A Case of Recurrent Small Bowel Cancer That Successfully Responded to Chemoradiation Therapy]. Gan To Kagaku Ryoho 2019; 46:705-708. [PMID: 31164511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Primary small bowel cancer is a rare entity; thus, it is often found in progress. Therefore, the prognosis is often poor. Because of its low frequency, there are few reports concerning the treatment for small bowel cancer; hence, it is important to examine individual cases in detail. In this study, we present a case of recurrent small bowel cancer that successfully responded to chemoradiation therapy. Case: A 48-year-old woman had anemia. Colonoscopy showed a tumor in the terminal ileum. Because of invasion in the ovaries and uterus, ileocecal resection, hysterectomy, and bilateral adnexectomy were performed. The pathological diagnosis was small bowel cancer with lymph node metastasis, and CapeOX therapy was administered as postoperative adjuvant chemotherapy. Since local recurrence was detected in the right lower quadrant 6 months after the surgery, IRIS plus BV was initiated. Radiation therapy(2Gy×25 times, total 50 Gy)was also administered within the same period(only S-1 administration during radiation). After radiation therapy, the tumor decreased significantly in size and showed CR. Currently, the patient is under observation without treatment, but she has had no recurrence for 6 years after the confirmation of recurrence(6 years and 6 months after surgery). It is extremely rare for chemoradiation therapy to be effective for recurrent small bowel cancer; we report such a case with literatures.
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Kitahara H, Honma Y, Ueno M, Kanemitsu Y, Ohkawa S, Mizusawa J, Furuse J, Shimada Y. Randomized phase III trial of post-operative chemotherapy for patients with stage I/II/III small bowel adenocarcinoma (JCOG1502C, J-BALLAD). Jpn J Clin Oncol 2019; 49:287-290. [PMID: 30590606 DOI: 10.1093/jjco/hyy188] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 11/23/2018] [Accepted: 12/07/2018] [Indexed: 01/10/2023] Open
Abstract
A randomized phase III trial was initiated in May 2017 to confirm the superiority of post-operative therapy with capecitabine and oxaliplatin over observation in terms of relapse-free survival in patients with curatively resected small bowel adenocarcinoma. Total 150 patients will be enrolled from 20 Japanese institutions over a period of 6.5 years. Relapse-free survival is the primary endpoint, while the secondary endpoints are overall survival, disease-free survival as defined by the Japan Clinical Oncology Group (JCOG), disease-free survival as defined by the International Rare Cancer Initiative (IRCI), and adverse events. Global phase III trial of IRCI to confirm the superiority of post-operative chemotherapy for small bowel adenocarcinoma was started in the UK in August 2015 (ClinicalTrials.gov Identifier: NCT02502370). An integrated analysis of the IRCI trial and our study are planned. Our trial has been registered in the UMIN Clinical Trials Registry as UMIN000027280 (http://www.umin.ac.jp/ctr/index.htm).
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Affiliation(s)
- Hideaki Kitahara
- Japan Clinical Oncology Group Data Center/Operations Office, National Cancer Center Hospital, Tokyo, Japan
| | - Yoshitaka Honma
- Department of Gastrointestinal Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Makoto Ueno
- Department of Gastroenterology, Hepatobiliary and Pancreatic Medical Oncology Division, Kanagawa Cancer Center, Kanagawa, Japan
| | - Yukihide Kanemitsu
- Department of Colorectal Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Shinichi Ohkawa
- Department of Gastroenterology, Hepatobiliary and Pancreatic Medical Oncology Division, Kanagawa Cancer Center, Kanagawa, Japan
| | - Junki Mizusawa
- Japan Clinical Oncology Group Data Center/Operations Office, National Cancer Center Hospital, Tokyo, Japan
| | - Junji Furuse
- Department of Medical Oncology, Kyorin University School of Medicine, Tokyo, Japan
| | - Yasuhiro Shimada
- Clinical Oncology Division, Kochi Health Sciences Center, Kochi, Japan
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10
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Akiyama S, Nagahori M, Oooka S, Negi M, Ito T, Takenaka K, Ohtsuka K, Watanabe M. Small intestinal obstruction due to the metastasis of intrahepatic cholangiocarcinoma: A case report. Medicine (Baltimore) 2018; 97:e0190. [PMID: 29561438 PMCID: PMC5895330 DOI: 10.1097/md.0000000000010190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
RATIONALE The small intestine (SI) does not commonly harbor cancer but is occasionally involved by metastatic cancer from other organs. To manage SI cancer appropriately, surveillance for primary origin outside the SI is essential. PATIENT CONCERNS This study presents a 54-year-old Thai man diagnosed with SI obstruction which required laparoscopy- assisted partial ileal resection. DIAGNOSES On the basis of the expression pattern of cytokeratins (CKs) and mucins (MUCs) in the resected SI adenocarcinoma, we suspected this was metastasized from the pancreatobiliary tract. Imaging studies revealed a hepatic segmental atrophy with an occlusion of the posterior segmental blanch of the portal vein without any contrast-enhanced lesions in the liver. Pathology of the liver biopsy revealed intrahepatic cholangiocarcinoma (ICC) with the same expression pattern of CKs and MUCs as the SI adenocarcinoma. INTERVENTIONS Systemic chemotherapy (gemcitabine and cisplatin) was initiated. OUTCOMES Despite of the chemotherapy for 20 months, he died of ICC. LESSONS This is the first case of SI obstruction caused by the metastasis of ICC. We demonstrate that immunohistochemical staining of CKs and MUCs discriminate between primary and metastatic SI cancer and predict its primary origin outside the SI. This case also suggests that a hepatic segmental atrophy with portal vein occlusion would be an atypical but important finding to diagnose ICC.
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Affiliation(s)
| | | | | | - Mariko Negi
- Department of Human Pathology, Tokyo Medical and Dental University, Yushima, Bunkyo-ku, Tokyo, Japan
| | - Takashi Ito
- Department of Human Pathology, Tokyo Medical and Dental University, Yushima, Bunkyo-ku, Tokyo, Japan
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11
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Ishikawa A, Tanigawa T, Hosomi S, Mori Y, Higuchi I, Akiyama Y, Hasuike Y. [Single Incision Laparoscopic Ileocecal Resection for Small Intestinal Malignant Lymphoma - A Case Report]. Gan To Kagaku Ryoho 2017; 44:1689-1691. [PMID: 29394744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
A 76-year-old man with the chiefcomplaint ofmelena visited our hospital. A mass was palpable in the right lower abdomen. We diagnosed the illness as small intestinal malignant lymphoma in the terminal ileum and performed a single incision laparoscopic ileocecal resection "TANKO-ICR" with D3 lymph node dissection with the idea ofobtaining a wide visualization and surgical field. The Aesculap®internal organ retractor(B BRAUN)is very useful in such cases. We grasped the pedicle of the ileocecal artery using the retractor and pulled out the nylon line connected to the retractor by using ENDO CLOSETM (COVIDIEN)to extraabdomen for drawing the pedicle. Single incision laparoscopic surgery can be performed with only an umbilical wound; therefore, it is minimally invasive and has a superior aesthetic outcome. Small intestinal malignant lymphoma is a relatively rare malignant tumor ofthe digestive organs. We report this case demonstrating that single incision laparoscopic surgery was possible and provide a review ofthe relevant literature.
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12
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Bernardes C, Pinho R, Rodrigues A, Proença L, Ponte A, Silva J, Rodrigues J, Sousa M, Carvalho J. Ileal metastasis of a Colorectal Carcinoma in an asymptomatic patient confirmed by Single-Balloon Enteroscopy. Acta Gastroenterol Belg 2017; 80:549-550. [PMID: 29560657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- C Bernardes
- Department of Gastroenterology, Centro Hospitalar de Lisboa Central
| | - R Pinho
- Department of Gastroenterology, Centro Hospitalar de Vila Nova de Gaia/Espinho, Portugal
| | - A Rodrigues
- Department of Gastroenterology, Centro Hospitalar de Vila Nova de Gaia/Espinho, Portugal
| | - L Proença
- Department of Gastroenterology, Centro Hospitalar de Vila Nova de Gaia/Espinho, Portugal
| | - A Ponte
- Department of Gastroenterology, Centro Hospitalar de Vila Nova de Gaia/Espinho, Portugal
| | - J Silva
- Department of Gastroenterology, Centro Hospitalar de Vila Nova de Gaia/Espinho, Portugal
| | - J Rodrigues
- Department of Gastroenterology, Centro Hospitalar de Vila Nova de Gaia/Espinho, Portugal
| | - M Sousa
- Department of Gastroenterology, Centro Hospitalar de Vila Nova de Gaia/Espinho, Portugal
| | - J Carvalho
- Department of Gastroenterology, Centro Hospitalar de Vila Nova de Gaia/Espinho, Portugal
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13
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Aomatsu N, Uchima Y, Aoyama Y, Tsujio G, Wang E, Yamakoshi Y, Nagashima D, Hirakawa T, Iwauchi T, Nishii T, Nakazawa K, Tei S, Takeuchi K. [A Case of Small Intestinal Malignant Lymphoma Presenting with Perforated Peritonitis]. Gan To Kagaku Ryoho 2016; 43:1833-1835. [PMID: 28133147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
An 85-year-old man presented to the emergency department with vomiting. He had tenderness in the left abdomen and under the umbilicus. Laboratory data showed an increase in the inflammatory response. Enhanced abdominal computed tomography showed thickening ofthe small intestinal wall in the lower left abdomen with a small amount ofadjacent free air. The fat tissue around the small intestine also revealed a high density area suggestive of inflammation. A diagnosis of peritonitis caused by intestinal perforation was made and an emergency operation was performed. We resected part of the ileum about 90 cm from the ileum end. The resected specimen showed a 1 by 1 cm mass with an ulcer and perforation at the base of the tumor. Histopathological findings revealed densely increased numbers of monomorphic medium-sized lymphoma cells infiltrating into all layers ofthe intestine. Immunohistochemically, the lymphocytes were positive for CD3, CD20, CD30, and CD79a. We diagnosed diffuse large B-cell lymphoma. Two cycles ofchemotherapy were given post-operatively. A recurrence was not observed. After chemotherapy he was transferred to rehabilitation.
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MESH Headings
- Aged, 80 and over
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Chemotherapy, Adjuvant
- Humans
- Ileal Neoplasms/complications
- Ileal Neoplasms/diagnostic imaging
- Ileal Neoplasms/drug therapy
- Ileal Neoplasms/surgery
- Intestinal Perforation/diagnostic imaging
- Intestinal Perforation/etiology
- Intestinal Perforation/surgery
- Lymphoma, Large B-Cell, Diffuse/complications
- Lymphoma, Large B-Cell, Diffuse/diagnostic imaging
- Lymphoma, Large B-Cell, Diffuse/drug therapy
- Lymphoma, Large B-Cell, Diffuse/surgery
- Male
- Peritonitis/diagnostic imaging
- Peritonitis/etiology
- Peritonitis/surgery
- Tomography, X-Ray Computed
- Treatment Outcome
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14
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Nako Y, Yamazaki S, Kitade T, Hariu T, Wakasa M, Nakanishi M, Sonoyama T. [A Giant Malignant Lymphoma of the Ileocecum Treated with Laparoscopic Surgery]. Gan To Kagaku Ryoho 2016; 43:2142-2144. [PMID: 28133249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
We experienced a case ofa giant malignant lymphoma ofthe ileocecum treated with laparoscopic surgery. A 78-year-old man presented with right flank pain. Lower endoscopy and abdominal computed tomography revealed a giant tumor in ileocecum. Biopsy results suggested malignant lymphoma or adenocarcinoma. We performed a laparoscopic ileocecal resection for definite diagnosis and treatment. The postoperative course was uneventful. The pathological diagnosis was malignant diffuse large B-cell lymphoma. The patient underwent chemotherapy and is being followed. Laparoscopic surgery can be considered useful to resect gastrointestinal malignant lymphoma.
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15
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Ohara N, Haraguchi N, Kudo T, Takahashi H, Nishimura J, Hata T, Matsuda C, Satoh T, Mizushima T, Yamamoto H, Doki Y, Mori M. [Recurrence of Jejunal Carcinoma in the Ileum and Ovary - A Case Report]. Gan To Kagaku Ryoho 2016; 43:1803-1805. [PMID: 28133137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Small bowel carcinoma has poor prognosis. The basis of treatment is surgical resection. There are no established guidelines for chemotherapy. We report a case in which we performed surgical resection of recurrent jejunal carcinoma. A 62-year-old woman underwent laparoscopic partial resection of the small intestine for primary jejunal carcinoma. The final diagnosis was T3N0M0, fStage II A. After 16 months of follow-up, she developed abdominal pain and vomiting. We diagnosed recurrence of jejunal carcinoma in the ileum and right ovary. Single-port laparoscopic small intestinal resection and right ovariectomy were performed. The patient underwent curative resection for recurrent lesions. The type of tumor in the ileum and right ovary was consistent with primary jejunal carcinoma by histopathological examination, and was diagnosed as recurrence of jejunal carcinoma. She is now on adjuvant chemotherapy with XELOX.
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Affiliation(s)
- Nobuyoshi Ohara
- Dept. of Gastroenterological Surgery, Graduate School of Medicine, Osaka University
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16
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Tsukamoto Y, Oshima H, Katsumori T, Hamaguchi H, Yamamoto S, Iwanaga T, Ohkawara S. [A Case of Small Intestinal Gastrointestinal Stromal Tumor(GIST)with Synchronous Colonic Cancer and Gastric Cancer at a Different Time]. Gan To Kagaku Ryoho 2016; 43:2112-2114. [PMID: 28133239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The patient was a 70-year-old woman with a gastrointestinalstromaltumor (GIST)of the small intestine and synchronous colonic cancer, who underwent laparoscopic right colectomy and resection of the small intestine. We started imatinib therapy because GIST belongs to a high-risk group, according to the modified Fletcher classification. Gastric cancer was diagnosed 2 years after the start of imatinib therapy. Only 4 of the 12 GIST cases seen at our institution over the last 5 years were complicated by another cancer. This is the first case of GIST in which 2 other cancers occurred at both the same and different times. We suggest that imatinib might be a factor in the development of gastric cancer.
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17
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Faggiano A, Malandrino P, Modica R, Agrimi D, Aversano M, Bassi V, Giordano EA, Guarnotta V, Logoluso FA, Messina E, Nicastro V, Nuzzo V, Sciaraffia M, Colao A. Efficacy and Safety of Everolimus in Extrapancreatic Neuroendocrine Tumor: A Comprehensive Review of Literature. Oncologist 2016; 21:875-86. [PMID: 27053503 DOI: 10.1634/theoncologist.2015-0420] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Accepted: 02/08/2016] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Everolimus, an oral mTOR (mammalian target of rapamycin) inhibitor, is currently approved for the treatment of progressive pancreatic neuroendocrine tumors (NETs). Although promising, only scattered data, often from nondedicated studies, are available for extrapancreatic NETs. PATIENTS AND METHODS A systematic review of the published data was performed concerning the use of everolimus in extrapancreatic NET, with the aim of summarizing the current knowledge on its efficacy and tolerability. Moreover, the usefulness of everolimus was evaluated according to the different sites of the primary. RESULTS The present study included 22 different publications, including 874 patients and 456 extrapancreatic NETs treated with everolimus. Nine different primary sites of extrapancreatic NETs were found. The median progression-free survival ranged from 12.0 to 29.9 months. The median time to progression was not reached in a phase II prospective study, and the interval to progression ranged from 12 to 36 months in 5 clinical cases. Objective responses were observed in 7 prospective studies, 2 retrospective studies, and 2 case reports. Stabilization of the disease was obtained in a high rate of patients, ranging from 67.4% to 100%. The toxicity of everolimus in extrapancreatic NETs is consistent with the known safety profile of the drug. Most adverse events were either grade 1 or 2 and easy manageable with a dose reduction or temporary interruption and only rarely requiring discontinuation. CONCLUSION Treatment with everolimus in patients with extrapancreatic NETs appears to be a promising strategy that is safe and well tolerated. The use of this emerging opportunity needs to be validated with clinical trials specifically designed on this topic. IMPLICATIONS FOR PRACTICE The present study reviewed all the available published data concerning the use of everolimus in 456 extrapancreatic neuroendocrine tumors (NETs) and summarized the current knowledge on the efficacy and safety of this drug, not yet approved except for pancreatic NETs. The progression-free survival rates and some objective responses seem promising and support the extension of the use of this drug. The site-by-site analysis seems to suggest that some subtypes of NETs, such as colorectal, could be more sensitive to everolimus than other primary NETs. No severe adverse events were usually reported and discontinuation was rarely required; thus, everolimus should be considered a valid therapeutic option for extrapancreatic NETs.
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Affiliation(s)
- Antongiulio Faggiano
- Thyroid and Parathyroid Surgery Unit, Istituto Nazionale per lo Studio e la Cura dei Tumori "Fondazione G. Pascale" - IRCCS, Naples, Italy
| | | | - Roberta Modica
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Daniela Agrimi
- District Hospital, Azienda Sanitaria Locale, Brindisi, Italy
| | - Maurizio Aversano
- Endocrinology Unit, Azienda Sanitaria Locale Napoli 3, Naples, Italy
| | - Vincenzo Bassi
- Unit of Internal Medicine, San Giovanni Bosco Hospital, Naples, Italy
| | - Ernesto A Giordano
- Endocrinology Unit, Azienda Sanitaria Provinciale di Calabria, Reggio Calabria, Italy
| | - Valentina Guarnotta
- Biomedical Department of Internal and Specialist Medicine, Section of Endocrinology, University of Palermo, Palermo, Italy
| | - Francesco A Logoluso
- Endocrinology Unit, Azienda Ospedaliero-Universitaria Consorziale Policlinico, Bari, Italy
| | - Erika Messina
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | | | - Vincenzo Nuzzo
- Unit of Internal Medicine, San Gennaro Hospital, Naples, Italy
| | | | - Annamaria Colao
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
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18
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Otsuru T, Iijima S, Tsujimura N, Nakao E, Matsumoto T, Takachi K, Nishioka K, Takemoto H, Oshima S, Uemura Y. [A Case of Small Intestinal Cancer Repeating an Ileus Symptom Complicated with Refractory Arrhythmia]. Gan To Kagaku Ryoho 2015; 42:1709-1711. [PMID: 26805146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
A 56-year-old man had been treated for hypertrophic cardiomyopathy since childhood. He had been treated for refractory ventricular tachycardia (VT) with interventricular septum cauterization, catheter ablation, and implantation of a defibrillator. He had been treated at home for several years. The ileus that developed in July 2014 was relieved by conservative medical treatment once, but it recurred after oral intake of food a short time later. The obstruction was due to a small intestine cancer that was diagnosed by enteroscopy. After considering the risks of surgery due to the cardiac problem and the quality of life due to ileus caused by the mass, we resected it. This surgery was not a radical resection because of peritoneal dissemination. He started oral food intake postoperatively, and returned to home care. Three months after surgery, oral chemotherapy was administered after considering his stable cardiac function in addition to his coherent mental status. An adverse event of severe watery diarrhea developed, and VT caused by dehydration occurred. After the chemotherapy was discontinued, he recovered in intensive care. He returned to home care at his prior status for 9 months postoperatively.
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19
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Yamashita S, Shimizu Y, Tominaga H, Kimura Y, Odagiri K, Kurokawa T, Yamaguchi M, Takahashi G, Sawada G, Moon J, Inoue M, Irei T, Nakahira S, Hatanaka N. [A Case of Small Bowel Cancer Treated with Laparoscopic Surgery]. Gan To Kagaku Ryoho 2015; 42:1712-1714. [PMID: 26805147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
We report a case of small intestinal adenocarcinoma treated with laparoscopic surgery. A 70-year-old woman had abdominal pain and epigastralgia. There were no abnormal findings on upper and lower endoscopy. The symptoms continued for 4 months after endoscopy, so she presented to our hospital. After CT examination, small bowel cancer with ileus was suspected. An ileus tube was inserted to relieve the bowel pressure and she was diagnosed with ileum cancer by enteroscopy. Laparoscopic surgery was performed and the pathological stage was determined as pStage Ⅲa. She was treated with oral chemotherapy (UFT plus LV) and had no recurrence 6 months after surgery.
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Affiliation(s)
- Shinya Yamashita
- Dept. of Surgery, National Hospital Organization Kure Medical Center and Chugoku Cancer Center
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20
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Tokura T, Nishikawa S, Yachi T, Umehara M, Umehara Y, Murata A, Takahashi K, Morita T. [A Case of Extranodal Nasal Type, NK/T Cell Lymphoma in the Ileum with Perforated Peritonitis during Chemotherapy]. Gan To Kagaku Ryoho 2015; 42:1298-1300. [PMID: 26489578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
A 65-year-old woman complaining of melena and a high fever was admitted to our hospital. Colonoscopy revealed a large tumor with a wide ulcer in the terminal ileum, and nasal type, extranodal NK/T cell lymphoma was suspected via biopsy. Owing to rapid progression of hepatocellular damage with hepatomegaly and splenomegaly, chemotherapy with CHOP was initiated immediately. Two days later, the patient developed panperitonitis, and emergency laparotomy was performed. The tumor in the terminal ileum widely adhered to the bladder, where a deep perforated ulcer was found, for which palliative ileocecal resection was performed. Enlargement of the residual tumor caused an abdominal abscess, intestinal obstruction, and hepatic failure, and the patient died 75 days after surgery. In summary, we initiated chemotherapy to control the deteriorating systemic condition of the patient. However, nasal type, extranodal NK/T cell lymphoma is a rapidly progressing lymphoma occasionally accompanied by perforation of the tumor. Surgery preceding chemotherapy should be considered an alternative treatment.
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21
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Capdevila J. Clinical scenario 1: Advanced, grade 2, neuroendocrine tumor in the midgut. Clin Adv Hematol Oncol 2014; 12:17-19. [PMID: 25768105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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22
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Pleşa A, Sarca E, Maxim R. Metastatic carcinoid tumor--atypical presentation. Rev Med Chir Soc Med Nat Iasi 2014; 118:1018-1023. [PMID: 25581963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Carcinoid tumor is a slow-growing type of neuroendocrine tumor, originating in the enterochromaffin cells and secreting mainly serotonin. Neuroendocrine tumors (NETs) are found throughout the intestinal tract, the appendix and terminal ileum being the most common locations, and are classified by site of origin and by degree of differentiation, with well-differentiated lesions representing those tumors formerly referred to as carcinoid tumors. The clinical symptoms are characterized by flushing, diarrhea, abdominal pain, and/or bronchial constriction and occur almost exclusively in patients with liver metastases due to the release of bioactive peptides and amines directly into the systemic circulation. We report the clinical, serological and histological diagnosis of a 67-years-old male patient with congestive heart failure secondary to carcinoid heart disease in the context of liver metastases of an ileum carcinoid tumor.
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Affiliation(s)
- Alina Pleşa
- University of Medicine and Pharmacy Grigore T. Popa - Iaşi, Department of Medical Specialties (I)
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23
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Tsukamoto A, Nakamura F, Nannya Y, Kobayashi Y, Shibahara J, Ichikawa M, Fukayama M, Koike K, Kurokawa M. MALT lymphoma of the small bowel with protein-losing enteropathy. Int J Hematol 2014; 99:198-201. [PMID: 24395281 DOI: 10.1007/s12185-013-1492-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2013] [Revised: 12/02/2013] [Accepted: 12/03/2013] [Indexed: 01/19/2023]
Abstract
Mucosa-associated lymphoid tissue (MALT) lymphoma usually arises from chronic inflammation. We herein report a case of small intestinal MALT lymphoma with protein-losing enteropathy (PLE). A 73-year-old woman presented with lower leg edema and severe hypoalbuminemia. She had a medical history of pylorus-preserving pancreaticoduodenectomy with Billroth II reconstruction. Oral and anal route double-balloon enteroscopies revealed irregular nodular mucosal lesions with erosion extending from the jejunum to terminal ileum. Histopathological evaluation of the biopsied mucosa showed proliferation of small-to-medium-sized lambda light chain-restricted B cells. Plasmacytic differentiation and lymphoepithelial lesions were present, leading to the diagnosis of MALT lymphoma. Tc-99m albumin scintigraphy indicated tracer exudation in the small bowel, suggesting the presence of PLE. Combination immunochemotherapy with rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone (R-CHOP) regimen improved both MALT lymphoma and PLE, whereas rituximab monotherapy was not successful. This case is considered to be common type of MALT lymphoma at an uncommon site and is distinct from immunoproliferative small intestinal disease (IPSID). To our knowledge, this is the first case of non-IPSID-type small intestinal MALT lymphoma complicated by PLE. Gastrointestinal reconstruction may be responsible for underlying chronic inflammation via small intestinal bacterial overgrowth.
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Affiliation(s)
- Ayato Tsukamoto
- Department of Hematology and Oncology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
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24
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Gómez V, Cheville JC, Baron TH. Richter transformation of the ileum presenting with gastrointestinal bleeding. Clin Gastroenterol Hepatol 2013; 11:e77. [PMID: 23524128 DOI: 10.1016/j.cgh.2013.02.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2013] [Accepted: 02/25/2013] [Indexed: 02/07/2023]
MESH Headings
- Aged
- Antigens, CD20/analysis
- Antineoplastic Agents/therapeutic use
- Endoscopy, Gastrointestinal
- Gastrointestinal Hemorrhage/etiology
- Gastrointestinal Hemorrhage/pathology
- Histocytochemistry
- Humans
- Ileal Neoplasms/complications
- Ileal Neoplasms/diagnosis
- Ileal Neoplasms/drug therapy
- Ileal Neoplasms/pathology
- Ileum/pathology
- Immunohistochemistry
- Lymphoma, Large B-Cell, Diffuse/complications
- Lymphoma, Large B-Cell, Diffuse/diagnosis
- Lymphoma, Large B-Cell, Diffuse/drug therapy
- Lymphoma, Large B-Cell, Diffuse/pathology
- Male
- Microscopy
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Affiliation(s)
- Victoria Gómez
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida
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25
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Suzuki O, Ishibashi K, Imaizumi H, Amano K, Hatano S, Matsuzawa T, Ogita T, Kuwabara K, Sobajima J, Ishiguro T, Higashi M, Fukuchi M, Kumamoto K, Baba H, Kumagai Y, Tsuji Y, Tamaru J, Mochiki E, Ishida H. [Outcomes of patients with small bowel carcinoma treated with appropriate chemotherapy selected on the basis of genetic analysis findings]. Gan To Kagaku Ryoho 2013; 40:1714-1716. [PMID: 24393898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Small bowel carcinoma is a rare tumor, for which a standardized chemotherapy regimen has not yet been established. Further, this tumor may belong to the group of Lynch syndrome-associated tumors, which are resistant to 5-fluorouracil (5-FU) -based chemotherapy. We investigated mismatch repair protein expression and K-ras gene mutation status in 8 patients with aggressive small bowel carcinoma and determined the chemotherapy regimen used in these patients. Immunohistochemical staining indicated normal mismatch repair protein expression in all surgical specimens. Of 8 patients, 4( 50%) had K-ras codon 12 mutations. Because small bowel carcinoma is not significantly associated with Lynch syndrome, 5-FU-based chemotherapy would be appropriate for the treatment of these patients. The prevalence of K-ras codon 12 mutations was relatively similar to that in patients with sporadic colorectal carcinoma, and the usefulness of anti- epidermal growth factor receptor (EGFR) antibody for the treatment of small bowel carcinoma should be evaluated in the future.
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Affiliation(s)
- Okihide Suzuki
- Dept. of Digestive Tract and General Surgery, Saitama Medical Center, Saitama Medical University
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26
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Mizutani M, Umino A, Taniguchi M, Tamaki S, Tanigawa M, Tsuji K. [Primary small intestinal Burkitt lymphoma treated with rituximab-combined CODOX-M/IVAC therapy without surgical resection]. Gan To Kagaku Ryoho 2013; 40:1229-1232. [PMID: 24047786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
A 38-year-old man complaining of abdominal pain was admitted to our hospital and diagnosed with small bowel obstruction. Whole body computed tomography(CT)scan showed moderate right pleural effusion with pleural and anterior chest wall thickening, with a mass approximately 100 mm in diameter at the terminal ileum. Histopathological and immunohistorical analysis of the endoscopic biopsy from the terminal ileum mass revealed diffuse infiltration of medium-sized, monotonous, atypical B lymphocytes with scanty basophilic cytoplasms carrying the so-called "starry sky" appearance, and primary small intestinal Burkitt lymphoma(BL)was diagnosed. Because of his advanced clinical stage(stage IV with Ann Arbor staging system)and the need for immediate treatment, he was promptly treated with cyclophosphamide and doxorubicin without surgical resection. Fortunately this initial therapy was received without the occurrence of bowel perforation. After initiating additional rituximab combined high-dose chemotherapy consisting of alternating courses of rituximab, cyclophosphamide, vincristine, doxorubicin, and methotrexate(R-CODOX-M)and rituximab, ifosfamide, etoposide, and cytarabine(R-IVAC), he achieved complete remission and remains without signs of disease now more than seven years after his last treatment. While further investigation will of course be needed, if possible, immediate chemotherapy without surgical resection is a treatment worth considering for improving the prognosis of those with small intestinal BL.
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Affiliation(s)
- Minoru Mizutani
- Dept. of Internal Medicine, Matsusaka Chuo General Hospital, Japan
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27
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Bruckner HW, Hrehorovich VR, Sawhney HS, Meeus SI, Coopeman AM. Chemotherapeutic Management of Small Bowel Adenocarcinoma Associated with Crohn's Disease. J Chemother 2013; 18:545-8. [PMID: 17127233 DOI: 10.1179/joc.2006.18.5.545] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Four patients with metastatic primary small bowel adenocarcinoma associated with Crohn's disease were successfully treated with low dose combination chemotherapy consisting of 5-fluorouracil, leucovorin and irinotecan with or without gemcitabine. Benefits included prolonged survival, objective responses, response of resistant tumors, downstaging, and a successful secondary complete resection (Ro) with a durable remission.
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Affiliation(s)
- H W Bruckner
- Medical Oncology, Lutheran Medical Center, 150-55th St., Brooklyn, NY 11220, USA.
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28
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Polyzos A, Kouraklis G, Giannopoulos A, Bramis J, Delladetsima JK, Sfikakis PP. Irinotecan as Salvage Chemotherapy for Advanced Small Bowel Adenocarcinoma: A Series of Three Patients. J Chemother 2013; 15:503-6. [PMID: 14598944 DOI: 10.1179/joc.2003.15.5.503] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Small bowel adenocarcinoma (SBA) is a relatively rare disease. Because of its rarity the role of chemotherapy either as adjuvant or for advanced disease has not been clearly defined. Therefore any information, including case reports, is warranted. We report on three patients with adenocarcinoma of the jejunum and ileum. Two patients with positive lymph nodes received postoperative adjuvant chemotherapy with 5-fluorouracil-folinic acid (5FU-FA) for 12 months but they developed metastatic disease 3 and 8 months later, respectively. The third patient was initially treated with the same agents but for metastatic disease. All patients were subsequently treated for tumor recurrence with irinotecan 350 mg/m2 i.v. every 3 weeks as salvage chemotherapy supported by Granulocyte Colony Stimulating Factor (GCSF) for 5 days. Two patients achieved a minor response and had a dramatic improvement of their symptoms. Their survival times after irinotecan administration were 14 and 6 months with an overall survival after primary diagnosis of 29 and 27 months, respectively. The third patient who had a tumor refractory to 5FU-FA progressed also on irinotecan and had an 8-month overall survival. Although conclusions cannot be drawn regarding the role of adjuvant chemotherapy in SBA, it seems reasonable to extrapolate from large bowel carcinoma experience. Irinotecan seems to have some degree of activity in the treatment of SBA but further studies are warranted.
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Affiliation(s)
- A Polyzos
- Medical Oncology Unit, Laikon General Hospital, Athens University School of Medicine, Athens, Greece
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29
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Hanada N, Kawata K, Okamura S, Tomiyama N, Hori K. [Two cases of recurrent GIST successfully treated with imatinib mesylate at 100mg/day]. Gan To Kagaku Ryoho 2013; 40:803-805. [PMID: 23863663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Case 1: Recurrent tumors from gastric GIST in the liver and the abdominal wall showed partial response with 200mg/day imatinib and maintained partial response at 100mg/day. Case 2: Metastatic liver tumors from the jejunal GIST showed partial response with 200mg/day imatinib. The tumors have been enlarged for interruption of imatinib administration, however, re- treatment with imatinib resulted in partial response again and kept partial response at 100mg/day of imatinib. The two cases seldom encountered adverse events at 100mg/day of imatinib. There are some cases successfully treated with low-dose imatinib mesylate for recurrent GIST.
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30
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Terada T. Extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue (MALT lymphoma) of the ileum in a 35-year-old Japanese woman. Int J Clin Exp Pathol 2013; 6:951-956. [PMID: 23638229 PMCID: PMC3638108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/15/2013] [Accepted: 04/03/2013] [Indexed: 06/02/2023]
Abstract
MALT lymphoma of the ileum is extremely rare: only several cases have been reported. A 34-year-old woman presented abdominal pain and melena. Colorectal and small intestinal endoscopes revealed multiple tumors and ulcers of the entire ileum. Biopsy was taken. Histologically, the biopsy consisted of 6 tissue specimens taken from the various sites of the ileum. All the tissue specimens showed infiltration of small atypical cells resembling centrocyte-like cells (CLC). Immunoblastic cells were scattered, though the number was scant. Monocytoid, plasma cell differentiation, and germinal centers were seen. Lymphoepithelial lesions (LEL) were scattered. Some small atypical lymphocyte were destructive the vessels and stromal tissues. Giemsa and Gram stains demonstrated no Helicobacter pylori and any bacteria. Immunohistochemically, the atypical small lymphocytes were positive for vimentin, but negative for various kinds of cytokeratins (CKs), EMA, CEA and CA19-9. The CK highlighted the LEL. They were positive for CD45, and B-cell markers (CD20, CD79a, CD10, CD23, bcl-2). CD138-positive plasma cells were seen in large number. CD68-positive macrophages were scattered. CD30- and CD15-positive immunoblastic cells were scattered. Most of the lymphoid cells were negative for T-cell markers (CD3, CD4, CD5, CD45RO, and CD43) and negative for NK cell markers (CD56 and CD57). The lymphoid cells were positive for κ-chain but negative for λ-chain; thus the light chain restriction was seen. TdT and cyclin D1 were negative. P53 was positive and Ki-67 labeling index was 67%. The lymphoid cells were negative for neuroendocrine markers (NCAM, NSE, chromogranin, and synaptophysin). The pathological diagnosis was MALT lymphoma of the ileum. Post-biopsy imaging techniques including CT, MRI, PET endoscope and gallium scintigraphy identified no tumors and no lymphadenopathy in the body except the ileum. The stomach was free from MALT lymphoma. She was treated by low dose chemotherapy and strictly followed up.
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Affiliation(s)
- Tadashi Terada
- Department of Pathology, Shizuoka City Shimizu Hospital, Shizuoka, Japan.
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31
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Seshimo K, Toshima T, Mizuno K, Ikeda H, Kato H, Yamamura M, Kodera M, Oishi M, Yamashita Y, Tanaka N, Fujita H, Shibagaki K, Taniguchi H, Takeda H, Kobayashi K, Takita K, Nishie M, Iwakawa K. [A case of primary adenocarcinoma of small intestine responding to XELOX chemotherapy and leading to a partial metabolic response]. Gan To Kagaku Ryoho 2012; 39:833-834. [PMID: 22584343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
We report a case of adenocarcinoma of the small intestine responding to XELOX chemotherapy, leading to a partial metabolic response(PMR). The patient was a 58-year-old male with multiple peritoneal dissemination of adenocarcinoma of the small intestine. Chemotherapy with XELOX(L-OHP 130 mg/m² on day 1 , and capecitabine 1,000 mg/m2 on days 1-14)was performed. After 4 courses, a significant tumor reduction was obtained. This case suggests that chemotherapy with XELOX is a potential regimen for small intestinal adenocarcinoma.
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Affiliation(s)
- Ken Seshimo
- Department of Surgery, Tottori Municipal Hospital
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32
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Bassi M, Luigiano C, Pellicano R, Ferrara F, Fornelli A, Tassone D, D'Imperio N. Metastases of malignant melanoma to gastrointestinal tract: a rare event. GIORN ITAL DERMAT V 2012; 147:208-210. [PMID: 22481585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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33
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Terada T. One patient with double lymphomas: simultaneous gastric MALT lymphoma and ileal diffuse large B-cell lymphoma. Int J Clin Exp Pathol 2012; 5:260-263. [PMID: 22558482 PMCID: PMC3341684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 10/25/2011] [Accepted: 02/27/2012] [Indexed: 05/31/2023]
Abstract
Multiple different lymphomas in a single person are very rare. The author herein reports the case of a 69- year-old Japanese woman with double gastrointestinal lymphoma. The patient presented with epigastralgia. Endoscopic examination revealed erosions and elevation of the gastric body and a large ulcerated tumor of the terminal ileum. Biopsies were obtained from these lesions. The gastric lesion was MALT lymphoma with monocytoid B-cell proliferation and lymphoepithelial lesions. Light chain restriction was present. Helicobacter pylori were present on Giemsa stain. The gastric lesions did not regress despite of therapy, which were confirmed by follow-up biopsy. The ileal lesion was obvious diffuse large B-cell lymphoma. The lesion regressed by chemotherapy. The patient is now alive 3 years after the first presentation.
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MESH Headings
- Aged
- Anti-Bacterial Agents/therapeutic use
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Biomarkers, Tumor/analysis
- Biopsy
- Cell Proliferation
- Endoscopy, Gastrointestinal
- Female
- Helicobacter pylori/isolation & purification
- Humans
- Ileal Neoplasms/chemistry
- Ileal Neoplasms/drug therapy
- Ileal Neoplasms/microbiology
- Ileal Neoplasms/pathology
- Immunoglobulin Light Chains/analysis
- Immunohistochemistry
- Lymphoma, B-Cell, Marginal Zone/chemistry
- Lymphoma, B-Cell, Marginal Zone/drug therapy
- Lymphoma, B-Cell, Marginal Zone/microbiology
- Lymphoma, B-Cell, Marginal Zone/pathology
- Lymphoma, Large B-Cell, Diffuse/chemistry
- Lymphoma, Large B-Cell, Diffuse/drug therapy
- Lymphoma, Large B-Cell, Diffuse/microbiology
- Lymphoma, Large B-Cell, Diffuse/pathology
- Neoplasms, Multiple Primary
- Stomach Neoplasms/chemistry
- Stomach Neoplasms/drug therapy
- Stomach Neoplasms/microbiology
- Stomach Neoplasms/pathology
- Treatment Outcome
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Affiliation(s)
- Tadashi Terada
- Department of Pathology, Shizuoka City Shimizu Hospital Shizuoka, Japan.
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34
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Lee EYP, Leung AYH, Anthony MP, Loong F, Khong PL. Utility of 18F-FDG PET/CT in identifying terminal ileal myeloid sarcoma in an asymptomatic patient. Am J Hematol 2011; 86:1036-7. [PMID: 21800353 DOI: 10.1002/ajh.22077] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2011] [Revised: 04/28/2011] [Accepted: 05/02/2011] [Indexed: 11/11/2022]
Affiliation(s)
- Elaine Yuen Phin Lee
- Department of Diagnostic Radiology, University of Hong Kong, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong.
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35
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Ogura S, Yura M, Sakamoto T, Watanabe Y, Tani N, Yamakita T, Yamazaki M, Nishihara A, Takaishi K, Miyake Y, Mori H, Tamura S. [A case report of GIST of the small intestine with multiple liver abscesses]. Gan To Kagaku Ryoho 2011; 38:2375-2377. [PMID: 22202387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
We report a case of a woman in her fifties presenting with abdominal pain, headache and high fever. Blood examination showed a high CRP level and liver dysfunction, and then abdominal CT scan showed multiple liver masses and a 5 cm submucosal tumor of the small intestine. We diagnosed the multiple liver masses as liver abscesses, so we administered antibiotics. We suspected that the tumor was a cause of liver abscesses, and then performed a resection of the tumor and partial small intestine on the third day of hospitalization. We diagnosed the tumor as GIST because it was positive for c-kit and CD34 by immunohistochemistry. One of the resected liver nodules showed negative for c-kit and CD34, and we diagnosed it as a liver abscess. We performed percutaneous transhepatic abscess drainage (PTAD) because she ran into high fever after the operation, and then she recovered. We consider she has the possibility of liver metastasis, so we administered imatinib mesylate to her. No recurrence was found for 11 months after the operation. This case provides valuable information because there are few reports of GIST with liver abscesses.
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36
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Zhang L, Wang LY, Deng YM, Wang FH, Feng F, Chen YC, An X, Chen C, Xu RH, Li YH. Efficacy of the FOLFOX/CAPOX regimen for advanced small bowel adenocarcinoma: a three-center study from China. J BUON 2011; 16:689-696. [PMID: 22331723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
PURPOSE Small bowel adenocarcinoma (SBA) is a rare malignancy, and most patients present with unresectable or metastatic disease. Thus far, no standard chemotherapeutic regimen has been established and related data are scarce, especially in Eastern countries. The purpose of this multicenter study was to evaluate the efficacy and toxicity of oxaliplatin combined with fluoropyrimidines in Chinese patients with advanced SBA. METHODS Advanced SBA patients who received FOLFOX (5-fluorouracil/5-FU plus leucovorin and oxaliplatin)/ CAPOX (capecitabine plus oxaliplatin) as first-line chemotherapy between February, 2004 and October, 2010 were identified from 3 large medical centers in China. The response rate (RR), progression-free survival (PFS), overall survival (OS), and chemotherapy-associated toxicity were evaluated. Cox models were applied for multivariate analyses. RESULTS Of 34 patients, with SBA 28 received FOLFOX and 6 CAPOX. The objective response (OR) and disease control (DC) rates were 32.3% and 61.7%, respectively. The median PFS and OS were 6.3 and 14.2 months, respectively. The toxicity was tolerable, grade 3-4 toxicity was rare. In multivariate analysis, only multi-organ metastasis reached borderline significance for shorter PFS (p=0.059), but the variables of age (>65 years; p=0.001), and multi-organ metastasis (p=0.001) were significantly associated with poor OS. CONCLUSION To our knowledge, this multicenter retrospective study is the first and largest one among Asian studies at present estimating oxaliplatin combined with fluoropyrimidines as first-line chemotherapy for advanced SBA. FOLFOX/CAPOX is proved effective for advanced SBA in this study, but the results do not absolutely agree with previous studies from Western countries, showing that further studies are still needed.
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Affiliation(s)
- Le Zhang
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in Southern China, Guangzhou, Guangdong Province, China
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37
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De Dosso S, Molinari F, Martin V, Frattini M, Saletti P. Molecular characterisation and cetuximab-based treatment in a patient with refractory small bowel adenocarcinoma. Gut 2010; 59:1587-8. [PMID: 20732917 DOI: 10.1136/gut.2009.196428] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/08/2022]
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38
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Okubo K, Yoshioka S, Asukai K, Hata T, Nakanishi M, Maekawa T, Hama N, Kashiwazaki M, Taniguchi M, Tsujie M, Konishi M, Yano K, Fujimoto T. [A case report of primary adenocarcinoma of small intestine]. Gan To Kagaku Ryoho 2010; 37:2792-2794. [PMID: 21224715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
This is an account of a case of primary adenocarcinoma of the small intestine with peritoneal dissemination successfully treated with chemotherapy. A 64-year-old woman was admitted with a complaint of severe abdominal distension. Abdominal computerized tomography revealed a bowel obstruction with tumor and the remarkable small bowel dilation of oral side of tumor. The tumor was found at surgery to be at the ileum 15 cm proximal from the ileocecal region. Peritoneal dissemination was recognized around the ileocecal region, so ileum partial resection was performed for the primary cancer lesion and dissemination region. Pathological diagnosis of the resected specimen was adenocarcinoma with lymph nodes metastasis. The peritoneal dissemination consisted of metastatic adenocarcinoma from small intestine. After an operation, internal use of S-1 was performed as adjuvant chemotherapy. But a recurrent lesion at the ovarium was detected 6 months after surgery. The patient was subsequently treated with resection of the ovarium. For lung metastasis, the combination chemotherapy with mFOLFOX6 + bevacizumab was administered. Primary small intestinal adenocarcinoma is a rare disease, and it is often diagnosed as advanced cancer because of few characteristic symptoms. So carcinoma of the small intestine usually has a poor prognosis.
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Affiliation(s)
- Keita Okubo
- Dept. of Surgery, Hyogo Prefectural Nishinomiya Hospital
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39
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Grad S, Dumitraşcu D, Badea R, Iobagiu S, Pascu O. Ileal neuroendocrine tumor - ultrasonographic and capsule endoscopy appearance: a case report. Med Ultrason 2010; 12:245-248. [PMID: 21203604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
We present the case of a female patient admitted for an abdominal tumoral mass corresponding to large liver metastases. The abdominal ultrasonography detected a solid intestinal tumor. The capsule endoscopy showed a vegetative tumor on the terminal ileum. After intestinal and partial liver resection, the histologic examination identified a neuroendocrine tumor. The patient responded incompletely to standard chemotherapy. In the presence of large hypoechoic liver metastases, a neuroendocrine tumor should be suspected.
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Affiliation(s)
- Simona Grad
- 2nd Medical Clinic, University of Medicine and Pharmacy Iuliu Hatieganu Cluj Napoca, Str. Clinicilor No. 2-4, Cluj-Napoca, Romania
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40
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Sasaki Y, Natsuizaka M, Takano M, Suzuki M, Tsuyuguchi M, Nagasako T, Kawamura N, Kudo M, Tsuda I, Meguro J. [A case of primary adenocarcinoma of small intestine with multiple liver metastases successfully treated with mFOLFOX6]. Gan To Kagaku Ryoho 2009; 36:1927-1929. [PMID: 19920403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
A 60-year-old man was referred to our hospital since his stool examination was positive for occult blood. Colonoscopy showed a tumor of Bauhin's valve and terminal ileum. Biopsy of the tumor was performed and pathological examination revealed adenocarcinoma. No other lesions were detected by gastroduodenoscopy and double-balloon enteroscopy. CT also showed multiple liver metastases. Ileocecal resection was performed because of severe stenosis of the terminal ileum. Histopathological examination revealed moderately-differentiated adenocarcinoma of Bauhin's valve and the terminal ileum, and no adenocarcinoma was found in the cecum and ascending colon. He was diagnosed with primary adenocarcinoma of the ileum with multiple liver metastases. Chemotherapy with mFOLFOX6 was performed after surgical resection. After 5 courses of chemotherapy, abdominal CT showed marked regression of the liver metastases, and tumor marker (CA19-9) was normalized from 1,100 U/mL to 36 U/mL. Effectiveness of mFOLFOX6 for primary adenocarcinoma of small intestine is suggested.
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41
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Versaci A, Macrì A, Ieni A, Terranova M, Leonello G, Saladino E, Speciale G, Famulari C. [Gastrointestinal stromal tumour: our experience]. Chir Ital 2009; 61:161-169. [PMID: 19536989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Gastrointestinal stromal tumours (GISTs) are the most common mesenchymal neoplasms of the gastrointestinal tract. These tumours originate in Cajal interstitial cells and the majority are located in the stomach and small intestine. They frequently develop in males aged 50-60 years. The symptoms of GIST are non-specific and depend on the size and location of the lesion. Imaging difficulties impede an early diagnosis; sometimes these tumours represent an unexpected intraoperative finding or an emergency abdominal picture. GISTs are classified as tumours with low- and high-risk of malignancy, depending on tumour size and mitotic count. Tumour site and acute onset are also significant parameters for prognostic purposes. Fifteen patients with GIST - gastric in 7 cases, ileal in 6, jejunal in 1 and colonic in 1 - were treated surgically and, in 9 cases, with adjuvant therapy (chemotherapy in 4 patients and imatinib mesylate in 5). The mean follow-up was 38 months. No postoperative mortality was recorded, and the morbidity was 13.3%. Histological examinations documented 6 benign tumours and 9 malignancies. Two patients, one with gastric and one with colonic GIST, were lost to follow-up. One patient, with two synchronous gastric neoplasms (GIST + adenocarcinoma) died after 16 months, while the other 5 patients with gastric GIST are still alive; two patients with ileal GIST, treated with chemotherapy, died after 15 and 18 months, respectively. The mean survival of patients treated with imatinib mesylate was 36 months. Surgical management and the use of imatinib constitute the therapeutic gold standard for GIST. The use of imatinib mesylate is recommended today in the treatment of advanced GIST, especially in cases with liver and peritoneal metastases.
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Affiliation(s)
- Antonino Versaci
- Istituto di Chirurgia d'Urgenza e dei Trapianti di Organo, Università degli Studi di Messina
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42
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Ono M, Shirao K, Takashima A, Morizane C, Okita N, Takahari D, Hirashima Y, Eguchi-Nakajima T, Kato K, Hamaguchi T, Yamada Y, Shimada Y. Combination chemotherapy with cisplatin and irinotecan in patients with adenocarcinoma of the small intestine. Gastric Cancer 2009; 11:201-5. [PMID: 19132481 DOI: 10.1007/s10120-008-0484-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2008] [Accepted: 09/29/2008] [Indexed: 02/07/2023]
Abstract
BACKGROUND Small-bowel adenocarcinoma (SBA) is a rare tumor that has a poor response to chemotherapy and a poor prognosis. Treatment strategies for SBA have not been clearly established. METHODS All patients with SBA treated using a combination of cisplatin and irinotecan (IP) as first-line chemotherapy at the National Cancer Center Hospital in Japan between January 1999 and February 2007 were studied retrospectively. RESULTS Eight patients received IP as first-line chemotherapy. The median follow-up was 9.5 months (range, 4.2-37.5 months). The median number of cycles of IP was three (range, 1-5). The overall response rate (complete or partial response) was 12.5% (complete response, n = 0; partial response, n = 1). The disease control rate (complete or partial response or stable disease) was 75%. The median time to treatment failure was 4.5 months (95% confidence interval, 0.9-5.8 months), and overall survival was 17.3 months (range, 1.9-21.3 months). The most common adverse events were neutropenia and anorexia. CONCLUSION IP combination chemotherapy may be an acceptable option for patients with SBA. Further studies are warranted to determine the optimal chemotherapeutic regimen for SBA.
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Affiliation(s)
- Makiko Ono
- Gastrointestinal Oncology Division, National Cancer Center Hospital, Tokyo, Japan
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43
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Lahmar-Boufaroua A, Ben Slama S, Bouraoui S, Gharbi L, Goutallier C, Manai S, Gharbi W, Mzabi-Regaya S. [Review of 32 gastro-intestinal stromal tumours with CD117 antigen]. Tunis Med 2009; 87:133-136. [PMID: 19522447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
AIM The aim of this study is to review clinical data, histological and immunohistochemical findings and prognosis of stromal gastrointestinal tumors. METHODS A retrospective Study of 32 cases of stromal gastrointestinal tumors diagnosed in the Department of Pathology of Mongi Slim Hospital of Tunis from 1991 to 2004. RESULTS The average age of the patients was of 54.4 years, equal for sex. Tumors were essentially gastric (50%) and of the small intestine (37.5%). All the patients had surgical treatment. Gastro-intestinal Stromal Tumors or GIST represent the most frequent stromal tumor with 56.2% of cases. CONCLUSION After immunohistochimestry study, using CD117 antigen, this revision allows better management of GIST. Glivec is the standard treatment of advanced GIST.
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44
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Kikuchi M, Kamei S, Morirama Y, Tuchiya T, Miwa K, Yokoi S, Nakano M, Ehara H, Deguchi T, Hirose Y. [Case of urachal cancer treated by neoadjuvant chemotherapy with FOLFOX4 (oxaliplatin, 5-FU and leukovolin)]. Hinyokika Kiyo 2008; 54:557-559. [PMID: 18788447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
A 52-year-old woman was referred to our hospital for treatment of urachal cancer. She complained of supurapubic dull pain and gross hematuria. Computed tomography and magnetic resonance imaging showed a non-papillary sessile tumor, which was located on the dome of the bladder and invaded the small intestine. The tumor was diagnosed as Sheldon's stage IIIC urachal cancer. After three courses of neoadjuvant chemotherapy with FOLFOX4 (oxaliplatin, 5-FU and leukovolin), the tumor was reduced from 7 x 6 cm to 5.5 x 5 cm in size. Consequently, the patient underwent an en-bloc resection of the urachal tumor with the dome of the bladder and the parts of the ileum invaded by the tumor. One course of adjuvant chemotherapy (FOLFOX4) was performed. Surgical specimen revealed histologically well differentiated squamous carcinoma and invasion to the propria of the ileum. The surgical margins were negative for the cancer. For 1.5 years after the surgery, no local recurrence or distant metastasis has been observed.
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45
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Bronzino P, Colombini M, Ferro A, Gambetta G, Gennaro M, Ivaldi L, Revetria P. [Gastrointestinal stromal tumors: case reports and review of the literature]. G Chir 2008; 29:33-37. [PMID: 18252146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
The Authors describe four cases of gastrointestinal stromal tumours (GIST) two of them were localized in the stomach, the others in the ileum. GIST are neoplasms of mesenchymal origin which develop inside the wall of the digestive tract. The most frequent site is the stomach, followed by the small bowel; less commonly these tumors can affect the oesophagus, the colon and the rectum. GIST originate from precursors of the interstitial cells of Cajal, which are localized in the gastro-intestinal wall and are involved in the regulation of the peristalsis. The treatment is surgical resection. For advanced disease there is a new interesting treatment based on the imatinib, a tyrosine kinase inhibitor.
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Affiliation(s)
- P Bronzino
- Ospedale dei Poveri Infermi (Località S Bernardino), Ceva Struttura Complessa Chirurgia Generale, Italy
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46
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van den Akker JPC, Laméris JS, Hoekstra JBL. Patient with diarrhoea, abdominal pain and weight loss. Neth J Med 2007; 65:459-460. [PMID: 18079571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Affiliation(s)
- J P C van den Akker
- Department of Internal Medicine, Academic Medical Centre, University of Amsterdam, the Netherlands.
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47
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Thoennissen NH, Schliemann C, Brunnberg U, Schmidt E, Staebler A, Stegger L, Bremer C, Schleicher C, Mesters RM, Müller-Tidow C, Berdel WE. Chemotherapy in metastatic malignant triton tumor: report on two cases. Oncol Rep 2007; 18:763-7. [PMID: 17786333 DOI: 10.3892/or.18.4.763] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Malignant triton tumor (MTT) is a rare, highly malignant nerve sheath tumor with rhabdomyoblastic differentiation. Initial debulking surgery followed by adjuvant therapy is the current treatment of choice, but has very limited efficacy when optimal cytoreduction is not achieved by surgical procedure. Neoadjuvant therapy for MTT, to potentially facilitate subsequent surgery, eradicate micrometastatic lesions and, therefore, improve the therapeutical outcome, has never before been presented in literature. Here, we report on the multimodal management of two cases of advanced and metastatic MTT. Treatment modalities involved neoadjuvant and adjuvant chemotherapy, surgical resection, and radiation. In both cases, integrated Positron Emission Tomography/Computed Tomography (PET/CT) emerged as an important diagnostic tool for the reliable assessment of MTT response and metabolic remission.
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Affiliation(s)
- N H Thoennissen
- Department of Medicine, Hematology and Oncology, University of Münster, D-48149 Münster, Germany.
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48
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Cossaro M, Noce L, Bonutti A, Pecile P, Di Loreto C, Saro F, Intini S, Terrosu G. [An abdominal Burkitt's lymphoma in acute phase. Case report]. Minerva Pediatr 2006; 58:311-8. [PMID: 16832338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Burkitt's lymphoma is a highly malignant, aggressive and rapidly growing B-cell neoplasm, which has low long-term survival rates. Abdomen is the most frequent onset site of nonendemic Burkitt's lymphoma. The rapidity of volumetric doubling of this neoplasm frequently justifies an abdominal acute presentation, that may mime other less rare diseases. Symptoms are often misleading and make diagnosis difficult. The aim of this work is to report a case of a 13-year-old boy affected by terminal ileum Burkitt's lymphoma with hepatic metastasis, which initially was mistaken for acute appendicitis complicated by hepatic abscesses and, following a second surgical operation, for terminal-ileum inflammatory bowel disease. The rapidity of growth of this neoplasm justifies the finding, during the second surgical operation, of a mass that was not clinically manifested during first operation, carried out only a week ago. Clinical signs and instrumental investigations were not diagnostic, as well as the literature reports. The role of surgery remains controversial, and is usually limited to collection of specimens for histological diagnosis or to management of acute complications, as in our case report. Mostly treatment protocols are based on chemotherapy, because of the high sensibility of this neoplasm.
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Affiliation(s)
- M Cossaro
- Clinica Chirurgica, Policlinico Universitario, Udine, Italy.
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49
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Nakata W, Inoue H, Yoshida T, Tsuzihata M, Takahara S, Okuyama A. [A rare case of transitional cell carcinoma of the ileum segment arising 43 years after ureteroileocystoplasty due to tuberculous bladder atrophy]. Hinyokika Kiyo 2005; 51:813-6. [PMID: 16440730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
A 60-year-old woman visited our hospital complaining of fever up. She had undergone augmentation ileoplasty for tuberculous bladder atrophy 43 years age. Cystoscopy revealed a broadbased tumor on the ileal segment. Histopathological findings of the biopsy specimen demonstrated grade 3 transitional cell carcinoma. She was given 2 courses of chemotherapy (methotrexate, vincristine, adriamicin, cisplatin), but died of metastasis of carcinoma 4 months after diagnosis.
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Affiliation(s)
- Wataru Nakata
- The Department of Urology, Osaka University Graduate School of Medicine
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50
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Noronha V, Burtness B, Murren J, Duffy TP. Oxaliplatin Induces a Delayed Immune-Mediated Hemolytic Anemia: A Case Report and Review of the Literature. Clin Colorectal Cancer 2005; 5:283-6. [PMID: 16356307 DOI: 10.3816/ccc.2005.n.041] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
We report a case of a 59-year-old woman with metastatic carcinoma of the ileocecal region who received FOLFOX(oxaliplatin/leucovorin/5-fluorouracil) and bevacizumab therapy and exhibited a partial remission with minimal side effects. She developed a mild self-limited episode of immune-mediated hemolytic anemia during her 16th cycle of chemotherapy, which precluded her from receiving further oxaliplatin. We review the literature on oxaliplatin-induced immune-mediated hemolysis, including its mechanism, presenting symptoms, laboratory features, management, and implications for future therapy.
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Affiliation(s)
- Vanita Noronha
- Mid Valley Oncology/Hematology, P.C., 407 Gidney Avenue, Newburgh, NY 12550, USA.
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