1
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Liu Z, Wang R, Jiang R, Zhou Q. Complete resection after abemaciclib targeted therapy in a patient with mediastinal liposarcoma extensively invading the pericardium and major vessels. Asian J Surg 2024; 47:1853-1854. [PMID: 38182520 DOI: 10.1016/j.asjsur.2023.12.166] [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] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 12/25/2023] [Indexed: 01/07/2024] Open
Affiliation(s)
- Zhenkun Liu
- Lung Cancer Center & Institute, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Rulan Wang
- Lung Cancer Center & Institute, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Rui Jiang
- Lung Cancer Center & Institute, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Qinghua Zhou
- Lung Cancer Center & Institute, West China Hospital of Sichuan University, Chengdu, 610041, China.
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2
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Zhang X, Xu Q, Zhang Y. Remarkable response to pazopanib plus vivolumab in a patient with pericardial synovial sarcoma carrying a novel genotype BRCA2 c.968dupT: A case report. Thorac Cancer 2024; 15:667-671. [PMID: 38323364 DOI: 10.1111/1759-7714.15237] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 01/20/2024] [Indexed: 02/08/2024] Open
Abstract
Pericardial synovial sarcomas (PSS) have a low incidence rate and are highly invasive with a dismal prognosis. Standard treatment includes surgery, radiotherapy and chemotherapy but with limited response. Here, we report the case of a 15-year-old nonsmoking youngster diagnosed with PSS who developed disease relapsed from surgery after 1 month. Next-generation sequencing (NGS) using baseline tissue was performed, and BRCA2 c.968dupT was detected. Then pazopanib (a multitargeted inhibitor) plus nivolumab (an immune checkpoint inhibitor) was administered, with a partial response and progression-free survival of 14 months. BRCA2 c.968dupT has not previously been reported in PSS and its response to targeted combination immunotherapy are not well characterized. Here, we report the efficacy of pazopanib combined with nivolumab in a PSS patient harboring BRCA2 c.968dupT and also provide the clinical evidence of the utility of NGS in exploring actionable mutations for solid tumor. Combination therapy based on immunotherapy may be a potential treatment choice for PSS harboring BRCA2 mutation.
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Affiliation(s)
- Xing Zhang
- Graduate Collaborative Training Base of Hunan Cancer Hospital, Hengyang Medical School, University of South China, Hengyang, Hunan, China
- Lung Cancer and Gastrointestinal Unit, Hunan Cancer Hospital, Department of Medical Oncology, The Affiliated Cancer Hospital of Xiangya School of Medicine, Changsha, Hunan, China
| | - Qinqin Xu
- Department of Medical Oncology, Qinghai Provincial People's Hospital, Xining, Qinghai, China
| | - Yongchang Zhang
- Graduate Collaborative Training Base of Hunan Cancer Hospital, Hengyang Medical School, University of South China, Hengyang, Hunan, China
- Lung Cancer and Gastrointestinal Unit, Hunan Cancer Hospital, Department of Medical Oncology, The Affiliated Cancer Hospital of Xiangya School of Medicine, Changsha, Hunan, China
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3
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Chen LW, Li JY, Fan L. [Progress in treatment of primary mediastinal large B-cell lymphoma]. Zhonghua Xue Ye Xue Za Zhi 2024; 45:98-102. [PMID: 38527847 DOI: 10.3760/cma.j.cn121090-20230731-00041] [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: 03/27/2024]
Abstract
Primary mediastinal large B-cell lymphoma (PMBCL) is an aggressive B-cell lymphoma originating from the thymus, which has different clinical and biological characteristics from diffuse large B-cell lymphoma, NOS. PMBCL tends to occur in young women, usually presenting as a large anterior mediastinal mass. Most patients are in stage Ⅰ-Ⅱ at the time of presentation. There is no standard prognostic scoring system for PMBCL. Immunochemotherapy is commonly used in the treatment of PMBCL, but the optimal first-line treatment has not been determined, and the status of radiotherapy is controversial. The value of PET-CT guided therapy needs to be further verified. Relapsed/refractory PMBCL has a poor prognosis, while novel therapies such as PD-1 inhibitors, brentuximab vedotin, and CAR-T can help improve survival in these patients.
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Affiliation(s)
- L W Chen
- Department of Hematology, the First Affiliated Hospital with Nanjing Medical University, Jiangsu Province Hospital, Nanjing 210029, China
| | - J Y Li
- Department of Hematology, the First Affiliated Hospital with Nanjing Medical University, Jiangsu Province Hospital, Nanjing 210029, China
| | - L Fan
- Department of Hematology, the First Affiliated Hospital with Nanjing Medical University, Jiangsu Province Hospital, Nanjing 210029, China
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4
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Greene A, Wood L, Champion P, Castonguay M, Scheffler M, Deshaies C, Wood J, French D. Resection of a Large Growing Mediastinal Germ Cell Tumor Using a Multidisciplinary Approach. Curr Oncol 2023; 31:42-49. [PMID: 38275829 PMCID: PMC10814761 DOI: 10.3390/curroncol31010003] [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: 11/04/2023] [Revised: 12/19/2023] [Accepted: 12/19/2023] [Indexed: 01/27/2024] Open
Abstract
Mediastinal germ cell tumors (GCTs) are rare. Post-chemotherapy residual masses in patients with a nonseminomatous GCT require resection. A patient with a large mediastinal GCT involving the left subclavian artery, superior vena cava (SVC) and hilum of the right lung is presented. Despite a biochemical response to chemotherapy, the tumor enlarged on serial imaging. With guidance from medical oncology, a multidisciplinary surgical team, including cardiac anesthesia, cardiac surgery and thoracic surgery resected the tumor with a staged reconstruction of the SVC. The procedure was well tolerated and yielded clear margins. The final pathology showed a significant associated component of rhabdomyosarcoma.
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Affiliation(s)
- Alison Greene
- Division of Cardiac Surgery, Department of Surgery, Dalhousie University, Queen Elizabeth II Hospital, Halifax, NS B3H 2Y9, Canada; (A.G.)
| | - Lori Wood
- Division of Medical Oncology, Department of Medicine, Dalhousie University, Queen Elizabeth II Hospital, Halifax, NS B3H 2Y9, Canada
| | - Philip Champion
- Division of Medical Oncology, Department of Medicine, Dalhousie University, Queen Elizabeth Hospital, Charlottetown, PEI C1A 8T5, Canada;
| | - Mathieu Castonguay
- Department of Pathology, Dalhousie University, Queen Elizabeth II Hospital, Halifax, NS B3H 2Y9, Canada;
| | - Matthias Scheffler
- Division of Cardiac Anesthesia, Department of Anesthesia, Pain Management and Perioperative Medicine, Dalhousie University, Queen Elizabeth II Hospital, Halifax, NS B3H 2Y9, Canada
| | - Catherine Deshaies
- Division of Cardiac Surgery, Department of Surgery, Dalhousie University, Queen Elizabeth II Hospital, Halifax, NS B3H 2Y9, Canada; (A.G.)
| | - Jeremy Wood
- Division of Cardiac Surgery, Department of Surgery, Dalhousie University, Queen Elizabeth II Hospital, Halifax, NS B3H 2Y9, Canada; (A.G.)
| | - Daniel French
- Division of Thoracic Surgery, Department of Surgery, Dalhousie University, Queen Elizabeth II Hospital, Halifax, NS B3H 2Y9, Canada
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5
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Chen Y, Yang C, Huang C, Li S. Feasibility of resection after neoadjuvant chemotherapy for mediastinal yolk sac tumor. Asian J Surg 2023; 46:6008-6009. [PMID: 37739897 DOI: 10.1016/j.asjsur.2023.09.050] [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] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 09/06/2023] [Indexed: 09/24/2023] Open
Affiliation(s)
- Yongjiang Chen
- Department of Thoracic Surgery, National Clinical Research Center for Respiratory Disease, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Chao Yang
- Department of Thoracic Surgery, National Clinical Research Center for Respiratory Disease, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Can Huang
- Department of Critical Care Medicine, Minzu Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Shuben Li
- Department of Thoracic Surgery, National Clinical Research Center for Respiratory Disease, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
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6
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Mardani P, Kamran H, Ghaderpanah R, Geramizadeh B, Fouladi D, Shahriarirad R, Amirian A. A massive immature mediastinal teratoma treated with chemotherapy and surgical resection: a case report. J Cardiothorac Surg 2023; 18:294. [PMID: 37845684 PMCID: PMC10580578 DOI: 10.1186/s13019-023-02389-w] [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: 12/06/2022] [Accepted: 09/30/2023] [Indexed: 10/18/2023] Open
Abstract
BACKGROUND Teratoma is a type of germ cell tumor consisting of one or multiple tissues derived from germinal layers. The location and size of the tumor can cause various presentations. Here we report one of the largest ever cases of immature cystic teratoma. CASE PRESENTATION In this report, we presented a 24-year-old patient with dyspnea, chest pain, nausea, and anorexia. A computed tomography scan revealed a giant, right-sided mass measuring about 190 × 150 × 140 mm. Chemotherapy was initiated for the patient, followed by thoracotomy. Histopathological evaluation revealed the nature of the mass to be an immature mediastinal teratoma. CONCLUSION the incidence of immature mediastinal teratoma is uncommon, and due to its rarity, the diagnosis needs more profound evaluation studies such as radiological and pathological assessments. Immature teratomas are optimally treated by a combination of chemotherapy and complete resection.
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Affiliation(s)
- Parviz Mardani
- Thoracic and Vascular Surgery Research Center, Shiraz University of Medical Science, Shiraz, Iran
| | - Hooman Kamran
- Thoracic and Vascular Surgery Research Center, Shiraz University of Medical Science, Shiraz, Iran
- Students Research Committee, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Rezvan Ghaderpanah
- Students Research Committee, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Bita Geramizadeh
- Shiraz Transplant Research Center (STRC), Shiraz University of Medical Sciences, Shiraz, Iran
- Department of Pathology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Damoun Fouladi
- Thoracic and Vascular Surgery Research Center, Shiraz University of Medical Science, Shiraz, Iran
- Students Research Committee, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Reza Shahriarirad
- Thoracic and Vascular Surgery Research Center, Shiraz University of Medical Science, Shiraz, Iran.
- Students Research Committee, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Armin Amirian
- Thoracic and Vascular Surgery Research Center, Shiraz University of Medical Science, Shiraz, Iran
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7
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Zinzani PL, Thieblemont C, Melnichenko V, Bouabdallah K, Walewski J, Majlis A, Fogliatto L, Garcia-Sancho AM, Christian B, Gulbas Z, Özcan M, Perini GF, Ghesquieres H, Shipp MA, Thompson S, Chakraborty S, Marinello P, Armand P. Pembrolizumab in relapsed or refractory primary mediastinal large B-cell lymphoma: final analysis of KEYNOTE-170. Blood 2023; 142:141-145. [PMID: 37130017 PMCID: PMC10651864 DOI: 10.1182/blood.2022019340] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 03/02/2023] [Accepted: 04/10/2023] [Indexed: 05/03/2023] Open
Abstract
Previous analyses of the phase 2 KEYNOTE-170 (NCT02576990) study demonstrated effective antitumor activity and acceptable safety of pembrolizumab 200 mg given every 3 weeks for up to 35 cycles (∼2 years) in patients with relapsed/refractory (R/R) primary mediastinal B-cell lymphoma (PMBCL) whose disease progressed after or who were ineligible for autologous stem cell transplantation. The end points included objective response rate (ORR), progression-free survival (PFS), and duration of response (DOR) according to the investigator per 2007 Response Criteria; overall survival (OS); and safety. In this final analysis, median duration of follow-up was 48.7 months (range, 41.2-56.2). The ORR was 41.5% (complete response, 20.8%; partial response, 20.8%). The median DOR was not reached; no patients who achieved a complete response progressed at the data cutoff. The median PFS was 4.3 months; the 4-year PFS rate was 33.0%. The median OS was 22.3 months; the 4-year OS rate was 45.3%. At the data cutoff, 30 patients (56.6%) had any-grade treatment-related adverse events (AEs); the most common were neutropenia, asthenia, and hypothyroidism. Grade 3/4 treatment-related AEs occurred in 22.6% of the patients; no grade 5 AEs occurred. After 4 years of follow-up, pembrolizumab continued to provide durable responses, with promising trends for long-term survival and acceptable safety in R/R PMBCL.
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Affiliation(s)
- Pier Luigi Zinzani
- IRCCS Azienda Ospedaliero-Universitaria di Bologna Istituto di Ematologia "Seràgnoli," Bologna, Italy
- Dipartimento di Scienze Mediche e Chirurgiche, Università di Bologna, Bologna, Italy
| | | | - Vladimir Melnichenko
- Department of Medical Oncology, Pirogov National Medical Surgical Center, Moscow, Russia
| | - Krimo Bouabdallah
- Department of Hematology and Cellular Therapy, University Hospital, Bordeaux, France
| | - Jan Walewski
- Department of Lymphoid Malignancies, Maria Sklodowska-Curie National Research Institute of Oncology, European Reference Network, Warsaw, Poland
| | - Alejandro Majlis
- Department of Hemato-Oncology, Clinica Alemana de Santiago, Santiago, Chile
| | - Laura Fogliatto
- Department of Clinical Hematology, Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil
| | - A Martin Garcia-Sancho
- Department of Hematology, Hospital Universitario de Salamanca, Institute of Biomedical Research of Salamanca, Centro de Investigación Biomédica en Red Cáncer, Salamanca, Spain
| | - Beth Christian
- Division of Hematology, The James Cancer Hospital and Solove Research Institute, The Ohio State University, Columbus, OH
| | - Zafer Gulbas
- Department of Hematologic Oncology, Anadolu Medical Center, Gebze, Turkey
| | - Muhit Özcan
- Department of Hematology and Bone Marrow Transplantation Unit, Ankara University School of Medicine, Ankara, Turkey
| | | | - Herve Ghesquieres
- Department of Clinical Hematology, Lyon-Sud Hospital Center, Lyon, France
| | - Margaret A Shipp
- Department of Hematologic Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Seth Thompson
- Department of Medical Oncology, Merck & Co, Inc, Rahway, NJ
| | | | | | - Philippe Armand
- Department of Hematologic Oncology, Dana-Farber Cancer Institute, Boston, MA
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8
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Kuruvilla J. Targeted therapy in mediastinal gray zone lymphoma. Blood 2023; 141:2673-2674. [PMID: 37261857 DOI: 10.1182/blood.2023020396] [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] [Subscribe] [Scholar Register] [Indexed: 06/02/2023] Open
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9
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Santoro A, Moskowitz AJ, Ferrari S, Carlo-Stella C, Lisano J, Francis S, Wen R, Akyol A, Savage KJ. Nivolumab combined with brentuximab vedotin for relapsed/refractory mediastinal gray zone lymphoma. Blood 2023; 141:2780-2783. [PMID: 36898084 DOI: 10.1182/blood.2022017951] [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] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 02/02/2023] [Accepted: 03/01/2023] [Indexed: 03/12/2023] Open
Affiliation(s)
- Armando Santoro
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- IRCCS Humanitas Research Hospital-Humanitas Cancer Center, Rozzano, Milan, Italy
| | | | | | - Carmelo Carlo-Stella
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- IRCCS Humanitas Research Hospital-Humanitas Cancer Center, Rozzano, Milan, Italy
| | | | | | | | | | - Kerry J Savage
- Centre for Lymphoid Cancer, Division of Medical Oncology, BC Cancer, Vancouver, BC, Canada
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10
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De Jesus O, Pellot Cestero JE, Gómez-González FM, Vélez R. Primary non-gestational mediastinal choriocarcinoma metastatic to the brainstem. BMJ Case Rep 2022; 15:e248389. [PMID: 35365470 PMCID: PMC8977749 DOI: 10.1136/bcr-2021-248389] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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] [Accepted: 03/23/2022] [Indexed: 11/03/2022] Open
Abstract
Choriocarcinoma is a highly malignant tumour emerging from the syncytiotrophoblast divided into gestational and non-gestational presentations. Primary choriocarcinoma of the mediastinum is rare. Metastases to the brain often occur; however, brainstem involvement has not been reported for non-gestational choriocarcinoma. We described a middle-aged man who developed a complete left oculomotor nerve paralysis secondary to a brainstem tumour at the midbrain. The workup for the primary source of the brainstem tumour included a chest CT scan, which revealed a mediastinal mass. A mediastinal mass needle biopsy confirmed the diagnosis of primary mediastinal choriocarcinoma. Despite aggressive chemotherapy, the patient died 6 months after the initial presentation from neurological complications and multiorgan failure.
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Affiliation(s)
- Orlando De Jesus
- Neurosurgery, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico
| | - Joel E Pellot Cestero
- Neurosurgery, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico
| | - Frances M Gómez-González
- Pathology and Laboratory Medicine, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico
| | - Román Vélez
- Pathology and Laboratory Medicine, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico
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11
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Caso R, Jones GD, Bains MS, Hsu M, Tan KS, Feldman DR, Funt SA, Reuter VE, Bosl GJ, McHugh D, Huang J, Molena D, Amar D, Fischer G, Rusch VW, Jones DR. Outcomes After Multidisciplinary Management of Primary Mediastinal Germ Cell Tumors. Ann Surg 2021; 274:e1099-e1107. [PMID: 31977510 PMCID: PMC7371518 DOI: 10.1097/sla.0000000000003754] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE We examined management strategies, overall survival (OS), and progression-free survival (PFS) among patients with PMNSGCTs undergoing resection and multidisciplinary management at a high-volume institution. SUMMARY OF BACKGROUND DATA Outcomes after resection of PMNSGCTs are not well-characterized, with limited data on factors associated with survival. METHODS We reviewed patients with PMNSGCT who underwent resection between 1980 and 2019. Median follow-up was 3.4 years. Preoperative therapy (including use of bleomycin), surgical management, recurrence, and survival were examined. Factors associated with survival were analyzed using Cox regression. RESULTS In total, 113 patients were included [median age, 28 years (range, 16-65)]. Preoperative serum tumor markers (STMs) normalized/decreased in 74% of patients. Pathology included necrosis only (25%), teratoma +/- necrosis (20%), viable nonteratomatous germ cell tumor +/- teratoma (41%), and secondary somatic-type malignancy +/- teratoma (20%). Bleomycin chemotherapy was not associated with pulmonary complications or 90-day mortality. Patients receiving second-line chemotherapy followed by resection had significantly worse OS and PFS than patients receiving first-line chemotherapy followed by resection. On multivariable analysis, R1/R2 resection (HR, 3.92; P < 0.001) and increasing postoperative STMs (HR, 4.98; P < 0.001) were associated with shorter PFS; necrosis on pathology (HR, 0.42, P = 0.043) was associated with longer PFS. CONCLUSIONS In patients with PMNSGCT undergoing resection, completeness of resection, postoperative pathology, and postoperative STMs were associated with PFS. Induction bleomycin was not associated with pulmonary complications or mortality in patients undergoing resection. Patients undergoing second-line chemotherapy followed by resection have a poor prognosis, with long-term survival of 22%.
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Affiliation(s)
- Raul Caso
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Gregory D. Jones
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Manjit S. Bains
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Meier Hsu
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Kay See Tan
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Darren R. Feldman
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Samuel A. Funt
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Victor E. Reuter
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - George J. Bosl
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Deaglan McHugh
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - James Huang
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Daniela Molena
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - David Amar
- Department of Anesthesiology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Gregory Fischer
- Department of Anesthesiology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Valerie W. Rusch
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - David R. Jones
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
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12
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Morgenstern Y, Aumann S, Goldschmidt N, Gatt ME, Nachmias B, Horowitz NA. Dose-adjusted EPOCH-R is not superior to sequential R-CHOP/R-ICE as a frontline treatment for newly diagnosed primary mediastinal B-cell lymphoma: Results of a bi-center retrospective study. Cancer Med 2021; 10:8866-8875. [PMID: 34816617 PMCID: PMC8683525 DOI: 10.1002/cam4.4387] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Revised: 09/22/2021] [Accepted: 10/19/2021] [Indexed: 12/27/2022] Open
Abstract
Purpose Primary mediastinal B‐cell lymphoma (PMBCL) is a rare subtype of diffuse large B‐cell lymphoma (DLBCL). Despite its aggressive course, PMBCL is considered curable. While in recent years dose‐adjusted (DA) EPOCH‐R (rituximab, etoposide, prednisone, vincristine, cyclophosphamide and doxorubicin) has become widely endorsed as first‐line therapy for newly‐diagnosed PMBCL, the optimal treatment for this disease and the role of radiotherapy (RT) remains unclear. DA‐EPOCH‐R provides good clinical outcomes, albeit is associated with short‐ and long‐term toxicity. To address this issue, the current retrospective bi‐icenter analysis compared efficacy and toxicity of DA‐EPOCH‐R and a less toxic R‐CHOP/R‐ICE regimen used for the treatment of newly‐diagnosed PMBCL. Patients and Methods The study included all patients with a histologically confirmed PMBCL diagnosis treated with DA‐EPOCH‐R or R‐CHOP/R‐ICE between 01/2013‐12/2020 at two tertiary medical centers. Patient demographic and clinical data were derived from institutional electronic medical records. The analysis included 56 patients: 31 received DA‐EPOCH‐R and 25 – R‐CHOP/R‐ICE. Results At a median follow‐up of 1.9 years (IQR 3.1 years), similar progression‐free survival (2.1 versus 2.4 years; p = 0.7667), overall survival (2.5 versus 2.7 years; p = 0.8047) and complete response (80%) were observed in both groups. However, DA‐EPOCH‐R was associated with significantly longer hospitalization required for its administration (p < 0.001) and a trend for higher frequency of infections, stomatitis, thrombotic complications and febrile neutropenia‐related hospitalizations. Conclusion DA‐EPOCH‐R and R‐CHOP/R‐ICE provide similarly encouraging outcomes in newly‐diagnosed PMBCL patients. R‐CHOP/R‐ICE is associated with lower toxicity and significantly reduced hospitalization. Our findings suggest that this regimen may be considered as an alternative to DA‐EPOCH‐R in this patient population.
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Affiliation(s)
- Yael Morgenstern
- Department of Hematology and Bone Marrow TransplantationRambam Health Care CampusHaifaIsrael
| | - Shlomzion Aumann
- Department of HematologyHadassah Medical Center and Faculty of MedicineHebrew University of JerusalemJerusalemIsrael
| | - Neta Goldschmidt
- Department of HematologyHadassah Medical Center and Faculty of MedicineHebrew University of JerusalemJerusalemIsrael
| | - Moshe E. Gatt
- Department of HematologyHadassah Medical Center and Faculty of MedicineHebrew University of JerusalemJerusalemIsrael
| | - Boaz Nachmias
- Department of HematologyHadassah Medical Center and Faculty of MedicineHebrew University of JerusalemJerusalemIsrael
| | - Netanel A. Horowitz
- Department of Hematology and Bone Marrow TransplantationRambam Health Care CampusHaifaIsrael
- The Ruth and Bruce Rappaport Faculty of MedicineTechnion – Israel Institute of TechnologyHaifaIsrael
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13
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Burke GAA, Minard-Colin V, Aupérin A, Alexander S, Pillon M, Delgado R, Zsíros J, Uyttebroeck A, Dartigues P, Miles RR, Kazanowska B, Chiang AK, Haouy S, Bollard CM, Csoka M, Wheatley K, Barkauskas DA, Adamson PC, Vassal G, Patte C, Gross TG. Dose-Adjusted Etoposide, Doxorubicin, and Cyclophosphamide With Vincristine and Prednisone Plus Rituximab Therapy in Children and Adolescents With Primary Mediastinal B-Cell Lymphoma: A Multicenter Phase II Trial. J Clin Oncol 2021; 39:3716-3724. [PMID: 34570655 PMCID: PMC9150887 DOI: 10.1200/jco.21.00920] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 06/07/2021] [Accepted: 08/24/2021] [Indexed: 11/20/2022] Open
Abstract
PURPOSE A dose-adjusted etoposide, doxorubicin, and cyclophosphamide with vincristine and prednisone plus rituximab (DA-EPOCH-R) regimen has been shown to deliver excellent survival for adults with primary mediastinal large B-cell lymphoma (PMLBL) without the use of radiotherapy. No international prospective evaluation of this regimen has previously been reported in children and adolescents. PATIENTS AND METHODS We conducted an international single-arm phase II trial involving patients younger than age 18 years with PMLBL who were to receive six courses of DA-EPOCH-R. The primary end point was event-free survival (EFS). Overall survival and toxicity were also assessed. This trial was registered (ClinicalTrials.gov identifier: NCT01516567). RESULTS Analyses were based on 46 patients. The median age was 15.4 years (interquartile range: 14-16 years). The median follow-up was 59.0 months (interquartile range: 52.6-69.2 months). Fourteen events were observed (eight relapses or progressions (including three parenchymal CNS relapses), four residual lymphoma, and two second malignancies). The 4-year EFS was 69.6% (95% CI, 55.2 to 80.9), which did not differ from the rate observed historically (P = .59). Seven deaths occurred (six disease-related and one second malignancy). The overall survival was 84.8% (95% CI, 71.8 to 92.4). Twenty-two patients (48%) reached dose levels ≥ 4. Nonhematologic adverse events grade ≥ 3 or cardiac adverse events grade ≥ 2 occurred in 47 of 276 (17%) courses and 30 of 46 patients (65%). CONCLUSION DA-EPOCH-R did not improve the EFS compared with a historical control in this first prospective multisite international study of children and adolescents with PMLBL. Further studies are required to determine the optimum therapy for children and adolescents with this lymphoma.
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Affiliation(s)
- G. A. Amos Burke
- Department of Paediatric Haematology, Oncology and Palliative Care, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Veronique Minard-Colin
- Department of Pediatric and Adolescent Oncology, INSERM 1015, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Anne Aupérin
- Unit of Biostatistics and Epidemiology, Gustave Roussy, Oncostat 1018 INSERM, Labeled Ligue Contre le Cancer, Université Paris-Saclay, Villejuif, France
| | - Sarah Alexander
- Division of Haematology/Oncology, Hospital for Sick Children, Toronto, ON, Canada
| | - Marta Pillon
- Pediatric Hematology and Oncology, University of Padova, Padova, Italy
| | - Rafael Delgado
- Pediatric Hematology and Oncology, University of Valencia, Valencia, Spain
| | - József Zsíros
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Anne Uyttebroeck
- Department of Pediatric Hematology and Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Peggy Dartigues
- Department of Biopathology, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Rodney R. Miles
- Department of Pathology and ARUP Laboratories and Huntsman Cancer Institute, Salt Lake City, UT
| | - Bernarda Kazanowska
- Department of Pediatric Bone Marrow Transplantation, Oncology, and Hematology, Wroclaw Medical University, Wroclaw, Poland
| | - Alan K. Chiang
- Department of Paediatrics and Adolescent Medicine, Li Ka Shing Faculty of Medicine, Queen Mary Hospital, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Stéphanie Haouy
- Department of Paediatric Haematology, Oncology, CHU Arnaud de Villeneuve, Montpellier, France
| | - Catherine M. Bollard
- Center for Cancer and Immunology Research, Children's National Health System and The George Washington University, Washington, DC
| | - Monika Csoka
- Pediatric Hematology and Oncology, Semmelweis University, Budapest, Hungary
| | - Keith Wheatley
- Cancer Research UK Clinical Trials Unit, Institute of Cancer and Genomic Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Donald A. Barkauskas
- Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, CA
| | - Peter C. Adamson
- Oncology Development & Pediatric Innovation, Sanofi, Cambridge, MA
| | - Gilles Vassal
- Department of Clinical Research, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Catherine Patte
- Department of Pediatric and Adolescent Oncology, INSERM 1015, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Thomas G. Gross
- Department of Pediatrics, Center for Cancer and Blood Diseases, Children's Hospital Colorado, Aurora, CO
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Timmerman DM, Eleveld TF, Gillis AJM, Friedrichs CC, Hillenius S, Remmers TL, Sriram S, Looijenga LHJ. The Role of TP53 in Cisplatin Resistance in Mediastinal and Testicular Germ Cell Tumors. Int J Mol Sci 2021; 22:ijms222111774. [PMID: 34769213 PMCID: PMC8583723 DOI: 10.3390/ijms222111774] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [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] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 10/19/2021] [Accepted: 10/26/2021] [Indexed: 12/31/2022] Open
Abstract
Germ cell tumors (GCTs) are considered to be highly curable; however, there are major differences in the outcomes related to histology and anatomical localization. GCTs originating from the testis are, overall, sensitive to platinum-based chemotherapy, whereas GCTs originating from the mediastinum show a worse response, which remains largely unexplained. Here, we address the differences among GCTs from two different anatomical locations (testicular versus mediastinal/extragonadal), with a specific focus on the role of the P53 pathway. It was recently shown that GCTs with TP53 mutations most often localize to the mediastinum. To elucidate the underlying mechanism, TP53 knock-out lines were generated in cisplatin-sensitive and -resistant clones of the representative 2102Ep cell line (wild-type TP53 testicular GCT) and NCCIT cell line (hemizygously mutated TP53, mutant TP53 mediastinal GCT). The full knock-out of TP53 in 2102Ep and resistant NCCIT resulted in an increase in cisplatin resistance, suggesting a contributing role for P53, even in NCCIT, in which P53 had been reported to be non-functional. In conclusion, these results suggest that TP53 mutations contribute to the cisplatin-resistant phenotype of mediastinal GCTs and, therefore, are a potential candidate for targeted treatment. This knowledge provides a novel model system to elucidate the underlying mechanism of clinical behavior and possible alternative treatment of the TP53 mutant and mediastinal GCTs.
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15
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Testori A, Perfetti V, De Carlo C, Bossi P, Alloisio M, Mangiameli G. Locally advanced primary mediastinal atypical carcinoid successfully resected after neoadjuvant treatment: A case report. Thorac Cancer 2021; 12:2415-2419. [PMID: 34346158 PMCID: PMC8410547 DOI: 10.1111/1759-7714.14091] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 07/14/2021] [Accepted: 07/16/2021] [Indexed: 01/21/2023] Open
Abstract
Neuroendocrine tumors (NETs) are epithelial neoplasms with predominant neuroendocrine differentiation that arise in most organs of the body. Mediastinal NETs are very rare, and account for no more than 5% of all mediastinal tumors. R0 surgery represents the milestone of treatment. Here, we describe a case of a locally advanced primary atypical carcinoid of the mediastinum. This was initially considered inoperable due to infiltration of a great vessel and was successfully resected after neoadjuvant treatment as a result of very extensive surgery. Only through an accurate preoperative diagnosis and good radiological planning is it possible to obtain satisfactory oncological results.
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Affiliation(s)
- Alberto Testori
- Division of Thoracic SurgeryIRCCS Humanitas Research HospitalMilanItaly
| | - Vittorio Perfetti
- Internal Medicine UnitOncologia Oltrepò, Ospedale di Varzi, ASST PaviaPaviaItaly
| | - Camilla De Carlo
- Department of PathologyHumanitas Clinical and Research Center – IRCCSMilanItaly
| | - Paola Bossi
- Department of PathologyHumanitas Clinical and Research Center – IRCCSMilanItaly
| | - Marco Alloisio
- Division of Thoracic SurgeryIRCCS Humanitas Research HospitalMilanItaly
- Department of Biomedical SciencesHumanitas UniversityMilanItaly
| | - Giuseppe Mangiameli
- Division of Thoracic SurgeryIRCCS Humanitas Research HospitalMilanItaly
- Department of Biomedical SciencesHumanitas UniversityMilanItaly
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16
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Abstract
PURPOSE The objective of this study was to describe and analyze the clinicopathological features of primary choriocarcinoma (PCC) observed in male patients treated at the Samsung Medical Center between 1996 and 2020. MATERIALS AND METHODS We reviewed the clinical records of 14 male patients with PCC retrospectively to assess their demographic, histological, and clinical characteristics at the time of diagnosis as well as identify the treatment outcomes. RESULTS The median age of the patients was 33 years. The primary tumor site was the testicles in seven cases (50%), the mediastinum in six cases (43%), and the brain in one case (7%). The most common metastatic site was the lungs (79%), followed by the brain (43%). All patients with PCC received cytotoxic chemotherapy. Twelve patients had records of their response to cytotoxic chemotherapy; of these 12 patients, eight (8/12, 67%) achieved an objective response, and four (4/12, 33%) achieved stable disease response as the best response during chemotherapy. CONCLUSION It is known that most male PCC patients eventually develop resistance to cytotoxic chemotherapy and die. Factors such as poor response to chemotherapy, high disease burden, brain metastasis, and hemoptysis at the time of diagnosis are associated with shorter survival time in male PCC patients. Programmed death-1/programmed death-ligand 1 blockade therapy can be a salvage treatment for chemotherapy-resistant male PCC patients.
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Affiliation(s)
- Young Sok Ji
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Se Hoon Park
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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17
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Abstract
ABSTRACT A 13-year-old boy with mediastinal T-cell lymphoblastic lymphoma demonstrated an altered biodistribution with diffuse activity in subcutaneous white adipose tissue and decreased visceral activity on interim posttreatment FDG PET/CT. This altered biodistribution was attributed to administration of the chemotherapeutic enzyme l-asparaginase 3 hours preceding the PET/CT, altering adipocytes amino acid and glucose metabolism. Treatment response assessment was adversely affected by the altered biodistribution, emphasizing the importance of maximizing the time between chemotherapy and PET/CT during successive oncologic treatment cycles. Because adipocytes protect leukemic cells in culture from l-asparaginase, we hypothesize that white adipose tissue-altered biodistribution may be related to l-asparaginase resistance.
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Affiliation(s)
- Colin R Young
- From the Department of Radiology and Biomedical Imaging, Yale New Haven Hospital, New Haven, CT
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18
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Hirose S, Hasegawa N, Kawai H, Yamaura M, Mizui T, Komatsu Y, Nagase M, Sato M, Hattori J, Endo M, Yamamoto Y, Ishige K, Fukuda K, Hyodo I, Mizokami Y. Mediastinal Neuroendocrine Carcinoma Slowly Growing for 8 Years after Surgical Resection of Esophageal Squamous Cell Carcinoma. Intern Med 2020; 59:2505-2509. [PMID: 32641665 PMCID: PMC7662036 DOI: 10.2169/internalmedicine.4584-20] [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: 11/06/2022] Open
Abstract
A 70-year-old woman was referred to our department due to a solitary mediastinal tumor which gradually grew near the site of anastomosis for 8 years after radical surgery of esophageal squamous cell carcinoma. It was difficult to distinguish the lymph node recurrence of esophageal cancer from another tumor of unknown primary origin. Endoscopic ultrasound-guided fine-needle aspiration was performed, and the tumor was diagnosed to be neuroendocrine carcinoma. She received concurrent chemoradiotherapy with etoposide plus cisplatin. After the completion of chemoradiotherapy, the tumor disappeared. A solitary growing tumor which develops after radical resection of cancer would be better to be examined histologically in order to make an accurate diagnosis and select the most appropriate treatment.
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Affiliation(s)
- Suguru Hirose
- Division of Gastroenterology, Faculty of Medicine, University of Tsukuba, Japan
| | - Naoyuki Hasegawa
- Division of Gastroenterology, Faculty of Medicine, University of Tsukuba, Japan
| | - Hitomi Kawai
- Department of Pathology, University of Tsukuba Hospital, Japan
| | - Masamichi Yamaura
- Division of Gastroenterology, Faculty of Medicine, University of Tsukuba, Japan
| | - Tsuneo Mizui
- Division of Gastroenterology, Faculty of Medicine, University of Tsukuba, Japan
| | - Yoshiki Komatsu
- Division of Gastroenterology, Faculty of Medicine, University of Tsukuba, Japan
| | - Masaomi Nagase
- Division of Gastroenterology, Faculty of Medicine, University of Tsukuba, Japan
| | - Masashi Sato
- Division of Gastroenterology, Faculty of Medicine, University of Tsukuba, Japan
| | - Junji Hattori
- Division of Gastroenterology, Faculty of Medicine, University of Tsukuba, Japan
| | - Masato Endo
- Division of Gastroenterology, Faculty of Medicine, University of Tsukuba, Japan
| | - Yoshiyuki Yamamoto
- Division of Gastroenterology, Faculty of Medicine, University of Tsukuba, Japan
| | - Kazunori Ishige
- Division of Gastroenterology, Faculty of Medicine, University of Tsukuba, Japan
| | - Kuniaki Fukuda
- Division of Gastroenterology, Faculty of Medicine, University of Tsukuba, Japan
| | - Ichinosuke Hyodo
- Division of Gastroenterology, Faculty of Medicine, University of Tsukuba, Japan
| | - Yuji Mizokami
- Division of Gastroenterology, Faculty of Medicine, University of Tsukuba, Japan
- Endoscopic Center, University of Tsukuba Hospital, Japan
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Kato H, Fukushima T, Kobayashi T, Sekiguchi N, Kanda S, Koizumi T. [Mediastinal Growing Teratoma Syndrome during Chemotherapy, Presenting as a Huge and Inoperable Tumor]. Gan To Kagaku Ryoho 2020; 47:1497-1500. [PMID: 33130749] [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: 06/11/2023]
Abstract
A 22-year-old male was diagnosed with a metastatic nonseminomatous germ cell tumor in the mediastinum with an elevated serum alpha-fetoprotein(AFP)concentration. Histopathological findings following percutaneous biopsy revealed the presence of a mature teratoma. Bleomycin, etoposide, and cisplatin(BEP)chemotherapy resulted decreased his serum AFP. However, the tumor became enlarged and was deemed inoperable due to size. Radiographic examination indicated diffuse calcification of the tumor mass. Growing teratoma syndrome in a patient with a primary mediastinal nonseminomatous germ cell tumor is extremely rare.
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Affiliation(s)
- Hinako Kato
- Dept. of Comprehensive Cancer Therapy, Shinshu University School of Medicine
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20
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Mitomo H, Tabata T, Nonomura R, Oshima Y, Sasaki T, Ishibashi N, Sugawara T, Sagawa M, Kondo T, Murakami K. [Acute Megakaryoblastic Leukemia Developed after the Surgical Treatment of Mediastinal Malignant Germ Cell Tumor]. Kyobu Geka 2020; 73:543-546. [PMID: 32641675] [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: 06/11/2023]
Abstract
A 26-year-old man was admitted to our hospital for an examination of a mediastinal tumor. Chest computed tomography(CT) showed a giant anterior mediastinal tumor narrowing the trachea and right main bronchus. Although needle biopsy could not be done because of patient respiratory condition, non-seminomatous mediastinal germ cell malignant tumor was strongly suspected by high level of serum AFP without no abnormal finding in his testis. After 1 cycle of chemotherapy by cisplatin, etoposide and bleomycin, the mediastinal tumor decreased in size. Percutaneous biopsy was challenged, however, definite diagnosis could not be established and the surgical resection was performed. The tumor was pathologically diagnosed as mature teratoma with elements of a yolk-sac tumor and some sort of sarcoma. Sudden onset of back pain and thrombocytopenia were encountered 5 months after the operation. Hematologic examination confirmed acute megakaryoblastic leukemia, and remission-induction therapy and allogeneic hematopoietic stem cell transplantation were performed. Twelve months after the operation, the patient is well without recurrence of either disease.
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Affiliation(s)
- Hideki Mitomo
- Department of Thoracic Surgery, Tohoku Medical and Pharmaceutical University, Sendai, Japan
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21
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Fang L, Cui Y, Mi Y, Ru K, Sun Q, Qin T, Xu Z, Wang J, Xiao Z. Somatic ASXL1 p.R693X mutation identified by next generation sequencing in isolated myeloid sarcoma involving the mediastinum. Curr Med Res Opin 2020; 36:1003-1007. [PMID: 32286099 DOI: 10.1080/03007995.2020.1744121] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Introduction: Isolated myeloid sarcoma (MS) is characterized by extramedullary immature myeloid cell infiltration without bone marrow involvement. The diagnosis of isolated MS is sometimes difficult in cases without expression of typical immunohistochemical markers, such as CD64, MPO or lysozyme.Clinical presentation: We report a case of isolated MS involving the mediastinum, with negative staining of MPO and lysozyme, which was misdiagnosed for 20 months. A comprehensive analysis in our institution showed MS with a characteristic staining pattern positive for CD34, CD117 and CD33, but negative for MPO, lysozyme, CD3 and CD79a. Next-generation sequencing (NGS) targeting 112 acute myeloid leukemia (AML)- and myelodysplastic syndromes (MDS)-associated genes confirmed the existence of an ASXL1 p.R693X mutation with a frequency of 13.17% of total cells. The patient acquired sustainable remission under the alternative treatment of intermediate-dose cytarabine and decitabine.Discussion and conclusion: The ASXL1 p.R693X mutation, a truncated mutation, has been widely reported to be associated with poor prognosis in myeloid malignance. We report the role of this mutation and recommend the utilization of NGS to discover more profound pathobiological information with limited samples, facilitate the diagnosis, and further clarify the uncertainties of prognosis and treatment in more isolated MS patients.
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Affiliation(s)
- Liwei Fang
- MDS and MPN Center, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China
- State Key Laboratory of Experimental Hematology, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China
| | - Yajuan Cui
- Department of Hematology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Yingchang Mi
- Leukemia Center, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China
| | - Kun Ru
- Department of Pathology, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China
| | - Qi Sun
- Department of Pathology, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China
| | - Tiejun Qin
- MDS and MPN Center, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China
| | - Zefeng Xu
- MDS and MPN Center, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China
- State Key Laboratory of Experimental Hematology, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China
| | - Jianxiang Wang
- State Key Laboratory of Experimental Hematology, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China
- Leukemia Center, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China
| | - Zhijian Xiao
- MDS and MPN Center, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China
- State Key Laboratory of Experimental Hematology, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China
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22
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Fujii T, Kitahara S, Matsunaga T, Kobayashi S, Sahara N, Matsui T, Otsuka A, Ishida Y, Ishii H, Kurosaki Y, Itoh S, Hasegawa H, Ohno N. [Case of Primary Mediastinal Non-Seminomatous Germ Cell Tumor with Pathological Complete Response after Induction Chemotherapy and Residual Tumor Resection Accompanied by Late-Onset Bilateral Pneumothorax]. Gan To Kagaku Ryoho 2020; 47:87-90. [PMID: 32381869] [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: 06/11/2023]
Abstract
A man in his late teens presented to our hospital with left-sided chest pain. CT showed a 12 cm sized anterior mediastinal tumor and tiny nodules in the bilateral lower lobe of the lungs. The patient also had elevated serum AFP and hCG levels. Pathological findings of the CT-guided biopsy specimen suggested a yolk sac tumor, and no testicular abnormality was seen on ultrasound. Following whole body examination, he was diagnosed with primary mediastinal non-seminomatous germ cell tumor. After sperm cryopreservation, 4 courses of BEP(bleomycin[BLM]plus etoposide[ETP]plus cisplatin[CDDP]) chemotherapy were administered to normalize the tumor markers. The mediastinal tumor shrank but was still widely in contact with the left pulmonary artery. He underwent mediastinal tumor resection and segmentectomy of the left upper lobe via a median sternotomy. The maximum tumor size was 9 cm in diameter, and pathological examination of the specimen revealed only an immature teratoma with no malignant findings. At the same time, both the lower lung nodules were resected and pathologically identified as intrapulmonary lymph nodes. No recurrence was observed, but 6 months after surgery, he made an emergency visit to our department due to dyspnea. Bilateral pneumothorax was detected, and chest tube insertion was rapidly performed that improved with only right chest drainage. Cytology of the right hemorrhagic pleural effusion showed no evidence of malignancy. It was possible that a postoperative right-to-left shunt of the anterior mediastinum was present, leading to bilateral pneumothorax.
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Abstract
We experienced a pregnant woman with superior vena cava syndrome at 15 weeks of pregnancy who was diagnosed with primary mediastinal large B-cell lymphoma and given chemotherapy. In this case, the clinical courses of both the mother and infant were favorable without any serious complications because of close multidisciplinary cooperation. Based on a retrospective review of this case, the administration of CHOP-like regimens during the second and third trimesters appears relatively safe. Because pregnancy and continuation of pregnancy are rare in patients with hematopoietic malignancies, the accumulation of detailed information is important.
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Affiliation(s)
| | - Hiromi Omura
- Department of Hematology, Tottori Prefectural Central Hospital, Japan
| | - Yusuke Tokuyasu
- Department of Pathology, Tottori Prefectural Central Hospital, Japan
| | - Shu Nakamoto
- Department of Pathology, Tottori Prefectural Central Hospital, Japan
| | - Takayuki Tanaka
- Department of Hematology, Tottori Prefectural Central Hospital, Japan
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24
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Zinzani PL, Santoro A, Gritti G, Brice P, Barr PM, Kuruvilla J, Cunningham D, Kline J, Johnson NA, Mehta-Shah N, Manley T, Francis S, Sharma M, Moskowitz AJ. Nivolumab Combined With Brentuximab Vedotin for Relapsed/Refractory Primary Mediastinal Large B-Cell Lymphoma: Efficacy and Safety From the Phase II CheckMate 436 Study. J Clin Oncol 2019; 37:3081-3089. [PMID: 31398081 PMCID: PMC6864847 DOI: 10.1200/jco.19.01492] [Citation(s) in RCA: 108] [Impact Index Per Article: 21.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/17/2019] [Indexed: 01/28/2023] Open
Abstract
PURPOSE Primary mediastinal B-cell lymphoma (PMBL) is a rare but aggressive non-Hodgkin lymphoma with poor outcomes in patients with relapsed/refractory (R/R) disease. PMBL is characterized by high expression of programmed death-1 ligand and variable expression of CD30. Nivolumab, an anti-programmed death-1 immune checkpoint inhibitor, and brentuximab vedotin (BV), an anti-CD30 antibody-drug conjugate, may have synergistic activity in R/R PMBL. METHODS The expansion cohort of the open-label, phase I/II CheckMate 436 study enrolled patients with confirmed R/R PMBL who were previously treated with either autologous hematopoietic cell transplantation or two or more prior chemotherapy regimens if ineligible for autologous hematopoietic cell transplantation. Patients received nivolumab (240 mg intravenously) and BV (1.8 mg/kg intravenously) every 3 weeks until disease progression or unacceptable toxicity. Primary end points were investigator-assessed objective response rate (ORR) per the Lugano 2014 criteria and safety. RESULTS Thirty patients with PMBL were treated and evaluable. At a median follow-up of 11.1 months, ORR (95% CI) was 73% (54% to 88%), with a 37% complete remission rate per investigator, and ORR of 70% (51% to 85%), with a 43% complete metabolic response rate per independent review. Median duration of response, median progression-free survival, and median overall survival have not been reached. Eleven responders had consolidation with autologous (n = 5) or allogeneic (n = 6) transplantation. Treatment-related adverse events were reported in 25 patients (83%). Sixteen patients (53%) had grade 3 to 4 treatment-related adverse events; the most common were neutropenia (n = 9), thrombocytopenia (n = 3), and peripheral neuropathy (n = 3). There were no treatment-related deaths. CONCLUSION In patients with R/R PMBL, the combination of nivolumab plus BV represents a promising option, with high antitumor activity and a manageable safety profile.
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Affiliation(s)
| | - Armando Santoro
- IRCCS Humanitas Research Hospital, Humanitas University, Milan, Italy
| | | | | | | | - John Kuruvilla
- Princess Margaret Cancer Centre, Toronto, Ontario, Canada
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25
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Kelsey CR, Broadwater G, James O, Chino J, Diehl L, Beaven AW, Chang C, Koontz BF, Prosnitz LR. Phase 2 Study of Dose-Reduced Consolidation Radiation Therapy in Diffuse Large B-Cell Lymphoma. Int J Radiat Oncol Biol Phys 2019; 105:96-101. [PMID: 30858144 PMCID: PMC10171462 DOI: 10.1016/j.ijrobp.2019.02.055] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 02/04/2019] [Accepted: 02/26/2019] [Indexed: 01/19/2023]
Abstract
PURPOSE To evaluate the feasibility of reducing the dose of consolidation radiation therapy (RT) in diffuse large B-cell lymphoma. METHODS AND MATERIALS This phase 2 study enrolled patients with diffuse large B-cell lymphoma, not otherwise specified and primary mediastinal (thymic) large B-cell lymphoma in complete response on positron emission tomography-computed tomography imaging after ≥4 cycles of a rituximab/anthracycline-containing combination chemotherapy regimen. Consolidation RT used a dose of 19.5 to 20 Gy. The primary endpoint was 5-year freedom from local recurrence. RESULTS Sixty-two patients were enrolled between 2010 and 2016. Stage distribution was as follows: I to II (n = 49, 79%) and III to IV (n = 13, 21%). Bulky disease (defined as ≥7.5 cm or ≥10 cm) was present in 23 (40%) and 16 (28%) patients, respectively. Chemotherapy was R-CHOP (then list the drugs) in 58 (94%) and R-EPOCH (then list the drugs) in 4 (6%) with a median of 6 cycles. With a median follow-up of 51 months, 7 patients developed disease progression (6 outside the RT field, 1 within the RT field). Freedom from local recurrence at 5 years was 98% (90% lower confidence bound, 88%). Progression-free and overall survival at 5 years were 83% and 90%, respectively. CONCLUSIONS With more effective systemic therapy (e.g., addition of rituximab) and more refined chemotherapy response assessment (e.g., positron emission tomography-computed tomography), the dose of RT in combined modality treatment programs may potentially be reduced to 20 Gy. This achieves excellent local control with the potential to decrease acute and long-term side effects.
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Affiliation(s)
- Chris R Kelsey
- Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina.
| | - Gloria Broadwater
- Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, North Carolina
| | - Olga James
- Department of Radiology, Division of Nuclear Medicine, Duke University Medical Center, Durham, North Carolina
| | - Junzo Chino
- Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina
| | - Louis Diehl
- Department of Medicine, Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, North Carolina
| | - Anne W Beaven
- Department of Medicine, Division of Medical Oncology, University of North Carolina Medical Center, Chapel Hill, North Carolina
| | - Catherine Chang
- Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina
| | - Bridget F Koontz
- Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina
| | - Leonard R Prosnitz
- Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina
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Rehman P, Wali RM, Hassan A. Six-year-old boy with mediastinal mass. J PAK MED ASSOC 2019; 69:135. [PMID: 30623931] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Lymphoblastic lymphomas account for 20-30% of all non-Hodgkin lymphomas (NHL) in children, and most cases of childhood lymphoblastic lymphoma are T-cell type (T-LL). T-LL occurs most frequently in late childhood and adolescence; with male predominance of 2:1.We present a paediatric case with a right sided mediastinal mass causing mediastinal shift diagnosed as T-LL.
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Affiliation(s)
- Palwasha Rehman
- Department of Pediatric Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan
| | - Rabia Muhammad Wali
- Department of Pediatric Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan
| | - Aamna Hassan
- Department of Pediatric Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan
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27
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Yassin R, Hajeer A, Alshieban S, Syed G, Alahmari B, Alhejazi A, Alaskar A, Alzahrani M, Damlaj M. HLA genotype and response to nivolumab therapy in relapsed refractory primary mediastinal B-cell lymphoma. Curr Res Transl Med 2018; 67:31-33. [PMID: 30448276 DOI: 10.1016/j.retram.2018.11.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 11/02/2018] [Indexed: 01/24/2023]
Affiliation(s)
- Rehab Yassin
- Division of Hematology & HSCT, Department of Oncology, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Ali Hajeer
- King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; Department of Pathology & Laboratory Medicine, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Saeed Alshieban
- Department of Pathology & Laboratory Medicine, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Ghulam Syed
- Department of Medical Imaging, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Bader Alahmari
- Division of Hematology & HSCT, Department of Oncology, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Ayman Alhejazi
- Division of Hematology & HSCT, Department of Oncology, King Abdulaziz Medical City, Riyadh, Saudi Arabia; King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Ahmed Alaskar
- Division of Hematology & HSCT, Department of Oncology, King Abdulaziz Medical City, Riyadh, Saudi Arabia; King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Mohsen Alzahrani
- Division of Hematology & HSCT, Department of Oncology, King Abdulaziz Medical City, Riyadh, Saudi Arabia; King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Moussab Damlaj
- Division of Hematology & HSCT, Department of Oncology, King Abdulaziz Medical City, Riyadh, Saudi Arabia; King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.
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Modrego PJ, Arribas J. Spontaneous resolution of a mediastinal mass in a woman with myasthenia gravis. Neurologia 2018; 33:556-557. [PMID: 27452618 DOI: 10.1016/j.nrl.2016.05.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Accepted: 05/05/2016] [Indexed: 11/19/2022] Open
Affiliation(s)
- P J Modrego
- Servicio de Neurología, Hospital Miguel Servet, Zaragoza, España.
| | - J Arribas
- Servicio de Neurología, Hospital Miguel Servet, Zaragoza, España
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Koba T, Hirata H, Kijima T, Naito Y, Hamaguchi M, Suga Y, Kuroyama M, Koyama S, Iwahori K, Takimoto T, Nagatomo I, Takeda Y, Kida H. [A Case of Mediastinal Small Cell Lung Cancer in a Patient Receiving Mechanical Ventilation Who Was Successfully Treated with Chemotherapy and Finally Extubated]. Gan To Kagaku Ryoho 2018; 45:1335-1337. [PMID: 30237376] [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: 06/08/2023]
Abstract
BACKGROUND The efficacy and safety of chemotherapy for patients with lung cancer who are in need of intensive care, such as invasive mechanical ventilation, have not been established. CASE A 59-year-old woman consulted a doctor with complaints of dyspnea.She was intubated because of acute respiratory failure and transferred to our hospital.Enhanced CT images revealed advanced stenosis of her trachea due to a bulky mediastinal tumor.Cervical lymph node biopsy was performed, and she was diagnosed with mediastinal small cell lung cancer.She received combination chemotherapy with carboplatin and etoposide along with invasive mechanical ventilation.Chemotherapy was effective, and extubation was performed under careful bronchoscopic observation.Her general condition improved gradually, and she was discharged from our hospital on foot with ambulatory chemotherapy. CONCLUSION Even though patients with lung cancer develop respiratory failure and need invasive mechanical ventilation, they may be treated with effective chemotherapy and may be weaned from ventilation.
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Affiliation(s)
- Taro Koba
- Dept. of Respiratory Medicine and Clinical Immunology, Osaka University Graduate School of Medicine
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Shimizu J, Yazaki U, Kinoshita T, Tatsuzawa Y, Kawaura Y, Nonomura A. Primary Mediastinal Germ Cell Tumor in a Middle-Aged Woman: Case Report and Literature Review. Tumori 2018; 87:269-71. [PMID: 11693807 DOI: 10.1177/030089160108700412] [Citation(s) in RCA: 8] [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] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Although primary mediastinal germ cell tumors are found much more frequently among young males than among other people, we recently encountered a middle-aged woman with the disease. The patient was a 59-year-old woman who complained mainly of anterior chest pain. Chest CT scans revealed a nonhomogeneous mass measuring 7 x 7 cm in the anterior mediastinal area, accompanied by signs suggestive of mediastinal invasion of the tumor. Reduction surgery was performed. The pathologic diagnosis was mediastinal dysgerminoma. The patient received postoperative radiochemotherapy but died due to liver metastasis 11 months after surgery.
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Affiliation(s)
- J Shimizu
- Department of Surgery, Saiseikai Kanazawa Hospital, Japan.
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Ding L, Hu Y, Zhao K, Wei G, Wu W, Wu Z, Xiao L, Huang H. Pleural cavity cytokine release syndrome in CD19-directed chimeric antigen receptor-modified T cell therapy: A case report. Medicine (Baltimore) 2018; 97:e9992. [PMID: 29443792 PMCID: PMC5839873 DOI: 10.1097/md.0000000000009992] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [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: 11/25/2022] Open
Abstract
RATIONALE Cytokine release syndrome (CRS) is a common and potentially fatal complication of CAR-T cell therapy. However, compartment CRS is relatively rare in hematological malignancies, as well as in solid tumors. The pathogenesis and prognosis of compartment CRS are unclear and there is no standardized treatment yet. In this case report, we will introduce a patient developing pleural cavity CRS after CART19s infusion. PATIENT CONCERNS A 28-year-old woman was admitted for evaluation of mediastinal mass. Her relevant examinations were comoleted. DIAGNOSES She was diagnosed as diffuse large B cell lymphoma (DLBCL, non-GCB type). INTERVENTIONS She received chemotherapies including 1 cycle of R-DAEPORCH, 1 cycle of R-CHOPE, 2 cycles of R-CHOP, and 4 cycles of R-GDP during the disease course. OUTCOMES The cytokine levels of hydrothorax were considerably high when serum cytokines were within normal range, with IL-6 at 1212.45 versus 5.69 pg/mL. qPCR analysis for CAR constructs showed 1,119,696 copies/μg DNA in hydrothorax and 522,227 copies/μg DNA in blood. LESSONS The results indicated that CART19 cells trafficked to the pleural cavity and interacted with the CD19-positive lymphoma cells directly, causing cytokine release in situ.
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Affiliation(s)
| | | | - Kui Zhao
- PET/CT Center, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou
| | | | | | - Zhao Wu
- Innovative Cellular Therapeutics Co., Ltd, Shanghai, China
| | - Lei Xiao
- Innovative Cellular Therapeutics Co., Ltd, Shanghai, China
| | - He Huang
- Bone Marrow Transplantation Center
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32
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Santos Silva J, Torres C, Teixeira JA, Garcia P, Calvinho P. Manubrium resection and reconstruction for mediastinal tumor: a case report. Rev Port Cir Cardiotorac Vasc 2018; 25:87-89. [PMID: 30317718] [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] [Received: 06/18/2018] [Indexed: 06/08/2023]
Abstract
Primary mediastinal tumours with chest wall involvement represent technical challenges that may offer a survival benefit. Reconstruction with osteossynthesis material, bioprosthesis and muscle flaps is indicated to re-establish the excised component function. We report a case of a 30-year-old male with a primary mediastinal seminoma operated after chemotherapy with need for en bloc resection of the residual mass and manubrium with chest wall reconstruction. This type of surgery is rare and represents a technical challenge. Therefore, it should be performed in referral centers and with a multidisciliplinary approach.
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Affiliation(s)
- João Santos Silva
- Cardiothoracic Surgery Department, Hospital Beatriz Ângelo, Loures, Portugal
| | - Carolina Torres
- General Surgery, Emergency Department, Hospital Beatriz Ângelo, Loures, Portugal
| | | | - Pedro Garcia
- Plastic and Reconstructive Surgery Department, Hospital Beatriz Ângelo, Loures, Portugal
| | - Paulo Calvinho
- Cardiothoracic Surgery Department, Hospital Beatriz Ângelo, Loures, Portugal
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Huang J, Tan Y, Zhen Z, Lu S, Sun F, Zhu J, Wang J, Liao R, Sun X. Role of post-chemotherapy radiation in the management of children and adolescents with primary advanced malignant mediastinal germ cell tumors. PLoS One 2017; 12:e0183219. [PMID: 28813488 PMCID: PMC5558937 DOI: 10.1371/journal.pone.0183219] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Accepted: 08/01/2017] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Primary malignant mediastinal germ cell tumors (MMGCTs) are rare in children and adolescents and have a poorer prognosis than their gonadal counterparts. We report a single institutional experience of a 10-year period of primary advanced MMGCTs treated with chemotherapy, followed by radiotherapy in those who had residual mass. METHODS Children and adolescents with primary advanced MMGCTs between 2005 and 2014 were identified from the Cancer Center, Sun Yat-Sen University. Medical records were reviewed for clinicopathological characteristics, treatments, and outcomes. RESULTS Twenty-four children and adolescents with either stage III or IV primary advanced MMGCTs met the inclusion criteria. There were 23 males and one female with a median age of 16 (range 10-18). Seven cases were seminomas (29.2%); four (16.7%) yolk sac tumors (YST); three (12.5%) choriocarcinomas; and ten (41.6%) nonteratomatous combined germ cell tumors (CGCTs). All patients were treated with first-line cisplatin-based chemotherapy regimens (PEB: 19, VIP: 5). Thirteen (54.2%) and Twelve (50%) patients received surgery and radiotherapy, respectively. With a median follow-up of 46.2 months (range 9.6-124.8 months), a total of five (20%) patients died of disease progression; the five-year overall survival (OS) and disease-free survival (DFS) rates were 82.3% and 64.9%, respectively.-Seven patients with seminoma GCTs received post-chemotherapy irradiation were alive with sustained CR (5-year OS and DFS, 100%, respectively). Five patients with NSGCTs were administered irradiation and one relapsed 35 months later and died of metastasis (5-year OS, 100%; 5-year DFS 66.7%). Univariate analysis identified histology and stage were prognostic factors. CONCLUSION Multimodality treatment approach of chemotherapy followed by radiation consolidation ensured long-term survival in primary advanced MMGCTs. Further research is warranted to improve the prognosis of children with primary advanced MMGCTs.
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Affiliation(s)
- Junting Huang
- Department of Pediatric Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, Guangdong, P. R. China
| | - Yuting Tan
- Department of Radiation Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, Guangdong, P. R. China
| | - Zijun Zhen
- Department of Pediatric Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, Guangdong, P. R. China
| | - Suying Lu
- Department of Pediatric Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, Guangdong, P. R. China
| | - Feifei Sun
- Department of Pediatric Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, Guangdong, P. R. China
| | - Jia Zhu
- Department of Pediatric Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, Guangdong, P. R. China
| | - Juan Wang
- Department of Pediatric Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, Guangdong, P. R. China
| | - Ru Liao
- Department of Pediatric Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, Guangdong, P. R. China
| | - Xiaofei Sun
- Department of Pediatric Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, Guangdong, P. R. China
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34
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Melani C, Major A, Schowinsky J, Roschewski M, Pittaluga S, Jaffe ES, Pack SD, Abdullaev Z, Ahlman MA, Kwak JJ, Morgan R, Rabinovitch R, Pan Z, Haverkos BM, Gutman JA, Pollyea DA, Smith CA, Wilson WH, Kamdar M. PD-1 Blockade in Mediastinal Gray-Zone Lymphoma. N Engl J Med 2017; 377:89-91. [PMID: 28679093 PMCID: PMC5628739 DOI: 10.1056/nejmc1704767] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
| | - Ajay Major
- University of Colorado School of Medicine, Aurora, CO
| | | | | | | | | | | | | | | | | | | | | | - Zenggang Pan
- University of Colorado School of Medicine, Aurora, CO
| | | | | | | | | | | | - Manali Kamdar
- University of Colorado School of Medicine, Aurora, CO
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35
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Ceriani L, Martelli M, Gospodarowicz MK, Ricardi U, Ferreri AJM, Chiappella A, Stelitano C, Balzarotti M, Cabrera ME, Cunningham D, Guarini A, Zinzani PL, Giovanella L, Johnson PWM, Zucca E. Positron Emission Tomography/Computed Tomography Assessment After Immunochemotherapy and Irradiation Using the Lugano Classification Criteria in the IELSG-26 Study of Primary Mediastinal B-Cell Lymphoma. Int J Radiat Oncol Biol Phys 2017; 97:42-49. [PMID: 27839910 DOI: 10.1016/j.ijrobp.2016.09.031] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Revised: 09/10/2016] [Accepted: 09/21/2016] [Indexed: 12/14/2022]
Abstract
PURPOSE To assess the predictive value of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) for disease recurrence after immunochemotherapy (R-CHT) and mediastinal irradiation (RT), using the recently published criteria of the Lugano classification to predict outcomes for patients with primary mediastinal large B-cell lymphoma. METHODS AND MATERIALS Among 125 patients prospectively enrolled in the IELSG-26 study, 88 were eligible for central review of PET/CT scans after completion of RT. Responses were evaluated using the 5-point Deauville scale at the end of induction R-CHT and after consolidation RT. According to the Lugano classification, a complete metabolic response (CMR) was defined by a Deauville score (DS) ≤3. RESULTS The CMR (DS1, -2, or -3) rate increased from 74% (65 patients) after R-CHT to 89% (78 patients) after consolidation RT. Among the 10 patients (11%) with persistently positive scans, the residual uptake after RT was slightly higher than the liver uptake in 6 patients (DS4; 7%) and markedly higher in 4 patients (DS5; 4%): these patients had a significantly poorer 5-year progression-free survival and overall survival. At a median follow-up of 60 months (range, 35-107 months), no patients with a CMR after RT have relapsed. Among the 10 patients who did not reach a CMR, 3 of the 4 patients (positive predictive value, 75%) with DS5 after RT had subsequent disease progression (within the RT volume in all cases) and died. All patients with DS4 had good outcomes without recurrence. CONCLUSIONS All the patients obtaining a CMR defined as DS ≤3 remained progression-free at 5 years, confirming the excellent negative predictive value of the Lugano classification criteria in primary mediastinal large B-cell lymphoma patients. The few patients with DS4 also had an excellent outcome, suggesting that they do not necessarily require additional therapy, because the residual 18F-fluorodeoxyglucose uptake may not reflect persistent lymphoma.
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Affiliation(s)
- Luca Ceriani
- Nuclear Medicine and PET-CT Center, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland.
| | - Maurizio Martelli
- Department of Cellular Biotechnologies and Hematology, Sapienza University, Rome, Italy
| | | | | | - Andrés J M Ferreri
- Unit of Lymphoid Malignancies, Department of Onco-Hematology, Istituto Di Ricovero e Cura a Carattere Scientifico (IRCCS) San Raffaele Scientific Institute, Milano, Italy
| | - Annalisa Chiappella
- Hematology, Azienda Ospedaliera Universitaria Città della Salute e della Scienza, Torino, Italy
| | - Caterina Stelitano
- Hematology, Azienda Ospedaliera Bianchi-Melacrino-Morelli, Reggio Calabria, Italy
| | | | - Maria E Cabrera
- Hematology, Hospital del Salvador, Universidad de Chile, Santiago, Chile
| | - David Cunningham
- Department of Medicine, The Royal Marsden National Health Service Foundation Trust, London and Surrey, United Kingdom
| | - Attilio Guarini
- Hematology Unit, Istituto Nazionale Tumori Giovanni Paolo II IRCCS, Bari, Italy
| | - Pier Luigi Zinzani
- Institute of Hematology and Medical Oncology, Policlinico S.Orsola-Malpighi, Bologna, Italy
| | - Luca Giovanella
- Nuclear Medicine and PET-CT Center, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - Peter W M Johnson
- Cancer Research UK Centre, University of Southampton, Southampton, United Kingdom
| | - Emanuele Zucca
- Oncology Department, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
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36
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Gleeson M, Hawkes EA, Cunningham D, Chadwick N, Counsell N, Lawrie A, Jack A, Smith P, Mouncey P, Pocock C, Ardeshna KM, Radford J, McMillan A, Davies J, Turner D, Kruger A, Johnson PWM, Gambell J, Linch D. Rituximab, cyclophosphamide, doxorubicin, vincristine and prednisolone (R-CHOP) in the management of primary mediastinal B-cell lymphoma: a subgroup analysis of the UK NCRI R-CHOP 14 versus 21 trial. Br J Haematol 2016; 175:668-672. [PMID: 27477167 DOI: 10.1111/bjh.14287] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Accepted: 06/22/2016] [Indexed: 11/30/2022]
Abstract
We performed a subgroup analysis of the phase III UK National Cancer Research Institute R-CHOP-14 versus R-CHOP-21 (two- versus three-weekly rituximab, cyclophosphamide, doxorubicin, vincristine and prednisolone) trial to evaluate the outcomes for 50 patients with World Health Organization 2008 classified primary mediastinal B-cell lymphoma identified from the trial database. At a median follow-up of 7·2 years the 5-year progression-free survival and overall survival was 79·8% and 83·8%, respectively. An exploratory analysis raised the possibility of a better outcome in those who received R-CHOP-14 and time intensification may still, in the rituximab era, merit testing in a randomised trial in this subgroup of patients.
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Affiliation(s)
- Mary Gleeson
- The Royal Marsden Hospital, London and Surrey, UK
| | - Eliza A Hawkes
- Department of Oncology and Clinical Haematology, Austin Health, Heidelberg, Melbourne, Australia
- Eastern Health, Melbourne, Australia
| | | | - Nick Chadwick
- Cancer Research UK and UCL Cancer Trials Centre, UCL Cancer Institute, London, UK
| | - Nicholas Counsell
- Cancer Research UK and UCL Cancer Trials Centre, UCL Cancer Institute, London, UK
| | - Anthony Lawrie
- Cancer Research UK and UCL Cancer Trials Centre, UCL Cancer Institute, London, UK
| | - Andrew Jack
- HMDS, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Paul Smith
- Cancer Research UK and UCL Cancer Trials Centre, UCL Cancer Institute, London, UK
| | - Paul Mouncey
- Cancer Research UK and UCL Cancer Trials Centre, UCL Cancer Institute, London, UK
| | | | - Kirit M Ardeshna
- University College London, London, UK
- Mount Vernon Cancer Centre, Northwood, UK
| | - John Radford
- The University of Manchester and the Christie NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | | | | | | | | | | | - Joanna Gambell
- Cancer Research UK and UCL Cancer Trials Centre, UCL Cancer Institute, London, UK
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Song HN, Kim SJ, Ko YH, Kim WS. Mediastinal Gray Zone Lymphoma with Features Intermediate between Classical Hodgkin Lymphoma and Primary Mediastinal B-Cell Lymphoma. Acta Haematol 2016; 136:186-90. [PMID: 27623181 DOI: 10.1159/000448159] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 12/03/2015] [Accepted: 06/22/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND Mediastinal gray zone lymphoma (MGZL) shares clinical characteristics with primary mediastinal B-cell lymphoma (PMBCL) and nodular sclerosing Hodgkin lymphoma (NSHL). However, MGZL is extremely rare, and an appropriate treatment for it has not yet been established. METHODS We retrospectively analyzed 8 patients who were treated with systemic chemotherapy for MGZL between 2007 and 2014. RESULTS The patients with MGZL were predominantly young and male (median age 26 years), and 62.5% of patients had bulky disease. The overall response rate (ORR) and complete remission (CR) rate were both 75% (6/8) for all treated patients The median overall survival (OS) and progression-free survival (PFS) was 40.7 and 3.9 months, respectively. Most responders (4/6, 66.7%) were treated with R-CHOP (rituximab + cyclophosphamide, hydroxydaunorubicin, Oncovin and prednisolone) as the frontline therapy. The CR rate of patients who received R-CHOP and those who did not was 100% (4/4) and 50% (2/4), respectively. Particularly striking was the finding that the median PFS of patients who received R-CHOP frontline chemotherapy was 11.4 months, which was superior to the median PFS of patients who did not receive R-CHOP. CONCLUSIONS Of the 8 patients with MGZL who were treated with systemic chemotherapy, superior treatment responses were observed in patients who received R-CHOP as the frontline therapy.
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Affiliation(s)
- Haa-Na Song
- Division of Hemato-Oncology, Department of Internal Medicine, Gyeongsang National University of Medicine and Gyeongsang National University Hospital, Jinju, Korea
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Fang LH, Shih LS, Lee PI, Chen WT, Chen RL. Mediastinal Germ Cell Tumor-associated Histiocytic Proliferations Treated With Thalidomide Plus Chemotherapy Followed by Alemtuzumab-containing Reduced Intensity Allogeneic Peripheral Blood Stem Cell Transplantation: A Case Report. Medicine (Baltimore) 2016; 95:e2515. [PMID: 26765473 PMCID: PMC4718299 DOI: 10.1097/md.0000000000002515] [Citation(s) in RCA: 4] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Mediastinal nonseminomatous germ cell tumor (MNSGCT)-associated histiocytic proliferations are rare and rapidly fatal disorders. Standard treatment modalities have yet to be established.We report a case of MNSGCT-associated hemophagocytic syndrome that evolved into malignant histiocytosis/disseminated histiocytic sarcoma (MH/HS), which was initially treated with intravenous immunoglobulin, corticosteroids, and cyclosporine. Then, thalidomide plus cyclophosphamide, adriamycin, oncovin, prednisolone chemotherapy followed by alemtuzumab-containing reduced-intensity allogeneic peripheral blood stem cell transplantation (PBSCT) was used as salvage therapy.The severe constitutional symptoms and pancytopenia resolved shortly after thalidomide with cyclophosphamide, adriamycin, oncovin, prednisolone. After PBSCT, the patient developed steroid-dependent skin graft-versus-host disease, but maintained a functional life for 1.5 years. Rapid resolution of chronic graft-versus-host disease preceded the fulminant recurrence of hemophagocytic syndrome and MH/HS.Thalidomide plus chemotherapy followed by alemtuzumab-containing reduced intensity allogeneic PBSCT is effective in allaying MNSGCT-associated histiocytic disorders, but does not prevent eventual relapse. However, further posttransplant immune modulation should be developed to completely eradicate the residual MH/HS cells.
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Affiliation(s)
- Li-Hua Fang
- From the Department of Pharmacy, Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan (L-HF); Department of Pathology, Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan (L-SH); Department of Nuclear Medicine, Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan (P-IL); Department of Internal Medicine, Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan (W-TC); and Department of Pediatric Hematology and Oncology, Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan (R-LC)
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Shimizu S, Inoue Y, Utsumi T, Okuma T, Kawaguchi T, Kasai T, Munakata S, Shibano M, Atagi S. Primary Marginal Zone Lymphoma in the Posterior Mediastinum with Pleural Involvement. Intern Med 2016; 55:2673-7. [PMID: 27629966 DOI: 10.2169/internalmedicine.55.6716] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
We herein report a case of primary marginal zone lymphoma (MZL) of the posterior mediastinum in an 84-year-old woman. Computed tomography of the chest showed a posterior mediastinal mass in the right thoracic paravertebral region with right pleural effusion. Pathological findings of a surgical biopsy from the posterior mediastinum, along with immunohistochemical and flow cytometric results, indicated MZL. The patient was treated with chemotherapy and radiation therapy for the mediastinal lesion and achieved complete remission. A relapse occurred 3 months after the initial treatment regimen. However, a second relapse has not occurred more than 2 years after second-line chemotherapy. This is the first case of MZL originating in the posterior mediastinum.
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Affiliation(s)
- Shigeki Shimizu
- Department of Laboratory Medicine and Pathology, National Hospital Organization Kinki-chuo Chest Medical Center, Japan
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40
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Kuno I, Matsumoto Y, Kasai M, Fukuda T, Hashiguchi Y, Ichimura T, Yasui T, Sumi T. Primary mediastinal choriocarcinoma with brain metastasis in a female patient. EUR J GYNAECOL ONCOL 2016; 37:265-266. [PMID: 27172760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Nongestational choriocarcinoma is very rare and carries a poor prognosis in female patients. In this report, the authors present a case of nongestational choriocarcinoma with brain metastasis in a female. A 58-year-old female with intermittent back pain was referred to a private hospital. On examination, a mediastinal tumor and a pancreatic tumor were detected. Endoscopic ultrasound-guided fine needle aspiration biopsy of the tumor was performed for histological evaluation. Pathological diagnosis was difficult because only a small amount of tissue was collected. Head MRI showed multiple metastatic tumors in the brain. The patient was diagnosed with primary mediastinal choriocarcinoma with brain metastasis. She was treated with one course of an etoposide, methotrexate, dactinomycin, cyclophosphamide, and vincristine regimen, but her general condition gradually deteriorated, and she died on day 41. Nongestational choriocarcinoma is drug resistant, whereas gestational choriocarcinoma has better chemotherapeutic sensitivity.
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Gallo K, Brickman A, Warren WH, Gattuso P, Seder CW. Unresectable Middle Mediastinal Biphasic Pulmonary Blastoma. Anticancer Res 2015; 35:6325-6327. [PMID: 26504071] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
We report a case of a young male who presented with an unresectable, centrally-located classic biphasic pulmonary blastoma (CBPB) involving his bilateral mainstem bronchi and esophagus and a synchronous right testicular seminoma. CBPB is a rare and aggressive tumor that most commonly presents as a solitary mass in the periphery of the lung. Surgical resection is the preferred treatment for CBPB, as chemotherapy and radiation have demonstrated limited effectiveness. In the current case, four cycles of cisplatin, ifosfamide, and etoposide with concurrent radiotherapy resulted in a favorable response at three months. Currently he optimal treatment for unresectable pulmonary blastomas remains undefined.
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Affiliation(s)
- Kelsey Gallo
- Department of Cardiovascular and Thoracic Surgery, Rush University Medical Center, Chicago, IL, U.S.A
| | - Arlen Brickman
- Department of Pathology, Rush University Medical Center, Chicago, IL, U.S.A
| | - William H Warren
- Department of Cardiovascular and Thoracic Surgery, Rush University Medical Center, Chicago, IL, U.S.A
| | - Paolo Gattuso
- Department of Pathology, Rush University Medical Center, Chicago, IL, U.S.A
| | - Christopher W Seder
- Department of Cardiovascular and Thoracic Surgery, Rush University Medical Center, Chicago, IL, U.S.A.
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Tong AK, Neo SH, Kok TY. Disseminated Lymphoma Evolving into Neurolymphomatosis during Mid-cycle of Chemotherapy Detected by (18)F-FDG PET/CT. Ann Acad Med Singap 2015; 44:545-547. [PMID: 27089963] [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: 06/05/2023]
Affiliation(s)
- Aaron Kt Tong
- Department of Nuclear Medicine and PET, Singapore General Hospital, Singapore
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43
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Desilva P, Datta D. Seminoma Presenting as a Mediastinal Mass in an Elderly Patient. Conn Med 2015; 79:527-530. [PMID: 26630703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Primary mediastinal germ cell tumors are relatively rare and represent 10% - 20% of all mediastinal tumors. About one-third of these are primary mediastinal seminomas, occurring in males in their third and fourth decades, with the median age of presentation ranging between 20 and 30 years of age. We report an unusual case of a 69-year old male with mediastinal seminoma, who presented at an age much higher than the usual affected patient and responded well to the conventional mode of therapy for this tumor. A review of literature pertaining to clinical presentation, diagnosis, and management is also presented.
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Bhardwaj M, Saha R, Misra DS, Malhotra V. Mediastinal Gray Zone Lymphoma. Indian J Chest Dis Allied Sci 2015; 57:255-257. [PMID: 27164737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
A 50-year-old male presented with cough and breathlessness. A positron emissoin tomography scan revealed FDG (Fluorodeoxyglucose) avid mediastinal mass. Tru-cut biopsy showed fibrotic stromal tissue with cellular infiltrate consisting of abnormal lymphoid cells and few large cells with smudged nucleus. Immunohistochemistry revealed diffuse positivity with CD20, focal positivity for CD30 and rare CD15 positive cells. Histological picture and immune profile showed overlaping features of non-Hodgkin's as well as Hodgkin's lymphoma. A diagnosis of mediastinal gray zone lymphoma was made. The patient showed a complete metabolic response to six cycles of chemotherapy.
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Hu CH, Li QL, Li HP, Fan SQ, Zhang HX, Liu XL, He Y, Huang M, Lu M, Wang SS, Wu F. Rare coexistence of mediastinal hepatoid adenocarcinoma, idiopathic azoospermia and horseshoe kidney: a case report and review of the literature. Int J Clin Exp Pathol 2015; 8:11741-11746. [PMID: 26617920 PMCID: PMC4637736] [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: 06/25/2015] [Accepted: 07/29/2015] [Indexed: 06/05/2023]
Abstract
Hepatoid adenocarcinoma (HAC) is the term proposed for a special type of extrahepatic tumors, which is similar to the hepatocellular carcinoma (HCC) both in the histopathology and immunohistochemistry. HAC has been observed in the stomach, colon, pancreas, gall bladder, lung and female genital tract, but rarely in the mediastinum. Now we describe a case of a 28-year-old Chinese male with primary mediastinal HAC with lung and liver metastasis. In this patient, HAC was associated with horseshoe kidney and idiopathic nonobstructive azoospermia. It seemed derivation abnormalities during organogenesis in the embryo stage played a significant role in the pathogenesis of HAC, horseshoe kidney and idiopathic nonobstructive azoospermia. Even the pathogenesis was still unknown; it may merit consideration of HAC together with horseshoe kidney and idiopathic nonobstructive azoospermia as a syndrome rather than as a spectrum of coincidental diseases. Furthermore, we found the HAC is a neoplasm with unfavorable outcomes despite aggressive and multi-protocol strategies. The serum alpha fetoprotein (AFP) should be regarded as a useful marker for diagnostic purposes and therapeutic response evaluation of HAC.
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Affiliation(s)
- Chun-Hong Hu
- Department of Oncology, The Second Xiangya Hospital of Central South University139 Middle Renmin Road, Changsha 410011, China
| | - Qiu-Li Li
- Depatment of Neurology, The First People’s Hospital of Chenzhou, University of South China102 Luojiajing Road, Chenzhou 423000, China
| | - Hai-Peng Li
- Depatment of Neurology, The First People’s Hospital of Chenzhou, University of South China102 Luojiajing Road, Chenzhou 423000, China
| | - Song-Qing Fan
- Department of Pathology, The Second Xiangya Hospital of Central South University139 Middle Renmin Road, Changsha 410011, China
| | - Hai-Xia Zhang
- Department of Oncology, The Second Xiangya Hospital of Central South University139 Middle Renmin Road, Changsha 410011, China
| | - Xian-Ling Liu
- Department of Oncology, The Second Xiangya Hospital of Central South University139 Middle Renmin Road, Changsha 410011, China
| | - Yan He
- Department of Oncology, The Second Xiangya Hospital of Central South University139 Middle Renmin Road, Changsha 410011, China
| | - Ming Huang
- Department of Oncology, The Second Xiangya Hospital of Central South University139 Middle Renmin Road, Changsha 410011, China
| | - Min Lu
- Department of Oncology, The Second Xiangya Hospital of Central South University139 Middle Renmin Road, Changsha 410011, China
| | - Si-Si Wang
- Department of Oncology, The Second Xiangya Hospital of Central South University139 Middle Renmin Road, Changsha 410011, China
| | - Fang Wu
- Department of Oncology, The Second Xiangya Hospital of Central South University139 Middle Renmin Road, Changsha 410011, China
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Rentas Torres Y, Rodríguez-López JL, Valentin M, Silva H. Difficult Diagnosis between B Cell Lymphoma and Classical Hodgkin's Lymphoma. Bol Asoc Med P R 2015; 107:98-101. [PMID: 26742206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Although primary mediastinal large B-cell lymphoma and classic Hodgkin lymphoma of nodular sclerosis type are distinct disease, they share several clinical characteristics and biologic features. However, there are mediastinal lymphomas that not fit in either category. These types of lymphomas are recognized as mediastinal gray zone lymphomas. Gray zone lymphomas are lymphatic tumors that cannot be assigned to a defined lymphoma entity due to morphological, clinical, or genetic reasons. In this report, we present a case of a 22 year-old-Hispanic-female diagnosed with B-cell lymphoma, unclassifiable, with features intermediate between diffuse large B-cell lymphoma and Hodgkin lymphoma.
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MESH Headings
- Antigens, Differentiation, B-Lymphocyte/analysis
- Antigens, Neoplasm/analysis
- Antineoplastic Combined Chemotherapy Protocols/administration & dosage
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- B-Lymphocytes/chemistry
- B-Lymphocytes/pathology
- Bone Marrow/pathology
- Cough/etiology
- Cyclophosphamide/administration & dosage
- Delayed Diagnosis
- Diagnosis, Differential
- Disease Management
- Doxorubicin/administration & dosage
- Dyspnea/etiology
- Female
- Hodgkin Disease/diagnosis
- Humans
- Lymph Nodes/pathology
- Lymphoma, B-Cell/diagnosis
- Lymphoma, B-Cell/diagnostic imaging
- Lymphoma, B-Cell/drug therapy
- Lymphoma, B-Cell/pathology
- Lymphoma, Large B-Cell, Diffuse/diagnosis
- Mediastinal Neoplasms/diagnosis
- Mediastinal Neoplasms/diagnostic imaging
- Mediastinal Neoplasms/drug therapy
- Mediastinal Neoplasms/pathology
- Positron-Emission Tomography
- Prednisone/administration & dosage
- Puerperal Disorders/diagnosis
- Rituximab/therapeutic use
- Tomography, X-Ray Computed
- Vincristine/administration & dosage
- Young Adult
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Solovyov AE, Morgun VV, Paholchuk AP. [NEUROBLASTOMA IN PEDIATRIC PATIENTS]. Klin Khir 2015:59-61. [PMID: 26521471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Neuroblastoma the most common malignant tumor of childhood, which is often localized in the retroperitoneal space, mainly in the adrenal glands, paravertebral retroperitoneal space, at rare in the posterior mediastinum, in the neck, presacral area. First symptoms of neuroblastoma are nonspecific, mimic various diseases. In the following clinical manifestations depend on the localization of the tumor, stage presence and location of metastases. In the diagnosis of neuroblastoma using ultrasonography and computed tomography. Of the 26 children whose neuroblastoma detected in different periods have died 12. Radical removal of the tumor only effective the first year of life. Chemotherapy is effective in 50% of operated children.
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Kwas H, Zendah I, Khattab A, Ismail O, Hantous S, Ghédira H. An exceptional localization of a rare tumor: primary sarcomatoid carcinoma of the mediastinum. Tunis Med 2015; 93:397-398. [PMID: 26644110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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49
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Giunta F, Zotta M, Menga M, Balma M, Bellò M, Passera R, Filippi AR, Chiappella A, Ladetto M, Ricardi U, Vitolo U, Bisi G. Using PET-CT in the restaging of primitive mediastinal B-cell lymphoma (PMBCL) after chemotherapy: which criteria should we use? Q J Nucl Med Mol Imaging 2015; 59:214-219. [PMID: 25669764] [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
AIM Primitive mediastinal B-cell lymphoma (PMBCL) is a relatively rare form of non-Hodgkin lymphoma (NHL), typically concerning the youngster, with an aggressive course and poor prognosis. The therapy generally consists of high dose chemotherapy followed by radiotherapy. PET-CT is used at staging, restaging after chemotherapy and after radiotherapy, or when relapse is suspected. Aim of the study was to compare different criteria in the evaluation of response to chemotherapy in this setting. METHODS Thirty-eight patients with PMBCL (15 M, 23 F, median age 33 yrs [range 18-79]), all treated with chemo-immunotherapy and radiotherapy, who had undergone baseline (b-PET) and end of chemotherapy (f-CHT-PET) 18F-FDG-PET-CT scans at our institution between July 2004 and September 2014 were retrospectively re-evaluated; the median follow-up was 42 months (range 4-109), at which 4/38 (11%) had died, 5/38 (13%) were in partial response (PR) and 29/38 (76%) were in complete response (CR). The primary endpoint was progression-free survival (PFS), while the secondary one was overall survival (OS), according to the Cheson criteria. SUV max of the mediastinal disease mass at staging, of the residual mass at CT after chemo-immunotherapy, SUV max of the liver and of the mediastinal blood pool (MBP) were calculated for all patients. RESULTS In our population, we observed that: 1) visual criteria performs better when positivity-negativity threshold is set at point 3 of the 5-point scale (5-PS); 2) semiquantitative approach by use of Δ SUV max performs better when the threshold is set at 66% decrease: in fact, at Δ SUV max analysis with 66% decrease, 9 patients resulted positive at the test (Δ SUV max ≤66%), 29 negative (Δ SUV max >66%). CONCLUSION In our population Δ SUV max could be working well in these patients because the baseline values are very high and very homogeneous. Our data, though limited in numerosity of patients and events, suggests that in this particular setting the use of the 5-PS reporting system could not be the best tool available; on the other hand, Δ SUV max could prove to be reliable in the evaluation of response to chemotherapy.
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Affiliation(s)
- F Giunta
- Division of Nuclear Medicine, Azienda Ospedaliera Universitaria, Città della Salute e della Scienza, Turin, Italy -
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Hamada A, Kanauchi N, Suzuki K, Watanabe H, Watanabe I. [Mediastinal Nonseminomatous Germ Cell Tumor with Sarcoid-like Reaction in the Regional Lymph Nodes]. Kyobu Geka 2015; 68:412-415. [PMID: 26066869] [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
A 26-year-old man was admitted because of an abnormal shadow on a chest roentgenogram. Computed tomography(CT) revealed a very large tumor in the anterior mediastinum and bilateral mediastinal lymphadenopathy. Examination of a CT-guided biopsy specimen revealed a yolk-sac tumor. The patient received 4 courses of bleomycin, etoposide, and cisplatin chemotherapy. After chemotherapy, the tumor was markedly reduced in size, but the lymphadenopathy remained. The patient underwent thoracoscopic biopsy of the mediastinal lymph nodes. Sarcoid nodules were found in all the biopsied nodes, and the lymphadenopathy was thought to be a sarcoid-like reaction associated with the germ cell tumor. Resection of the residual tumor was performed according to the treatment algorithm of the International Germ Cell Cancer Collaborative Group. There were no viable tumor cells in the resected tissue. The patient is free of recurrence and without any sign of generalized sarcoidosis 3 years after the surgery.
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Affiliation(s)
- Akira Hamada
- Department of General Thoracic Surgery, Nihonkai General Hospital, Sakata, Japan
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