Articles

An unusual complete remission of a diffuse metastatic squamous cell cutaneous carcinoma with an EGFR-TKI

BJMO - 2019, issue 2, february 2019

Maroun Sadek

Cutaneous squamous cell carcinoma is a malignant tumour of the epidermis which reproduces the appearance of keratinising cells. In frequency terms it is the second most common tumour among malignant cutaneous neoplasias.

For patients with disease not amenable to curative intent therapy, treatment options are limited to platinum-based chemotherapy regimens and more recently to the anti-PD1 immune checkpoint inhibitor.

Erlotinib is a receptor tyrosine Kinase inhibitor, which acts on the epidermal growth factor receptor(EGFR) and produces long-lasting responses with palliative benefit and relatively low toxicity, especially in patients with activating EGFR mutation

Hereby we describe the case of a 61-year-old patient diagnosed with a squamous cell carcinoma of the lower limbs, of the keratoacanthoma type, treated successively by surgical excision, isotretinoin acid, topical imiquimod and topical 5-FU without significant response. He then was started on Erlotinib 150mg od and has been in complete remission since > 3 years, knowing that his tumour does not harbour any significant mutation.

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From breast implants to squamous cell carcinoma

BJMO - 2019, issue 2, february 2019

Maroun Sadek

Squamous cell carcinoma is a malignant neoplasm of squamous cell of the epidermis, it has the potential for rapid growth and a low but significant risk of metsastasis and death. Chronically injured skin is one of the risk factors for the development of cutaneous Squamous cell carcinoma.

Hereby, we describe the case of a 44-year old woman who had a right breast prosthesis with many surgical re-interventions for aesthetic reasons, at least eight operations were done over nine years complicated each time by superimposed infections at the site of the interventions.

During the last procedure, skin biopsies revealed keratinizing, well-differentiated squamous cell carcinoma, tumor was infiltrating the lower quadrants of the breast, and deeply infiltrating the 3rd, 4th and 5th ribs along with lymph nodes involvement (axillary and internal mammary chain).

Six cycles of Carboplatine with Paclitaxel were received as neoadjuvant chemotherapy but unfortunately the fluorodeoxyglucose (FDG)-positron emission tomography (PET) showed a disease progression; subsequently we decided to go for surgical resection planned in the upcoming two weeks.

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A rare tumor of the parotid gland

BJMO - 2019, issue 2, february 2019

Maroun Sadek

Epithelial-myoepithelial carcinoma (EMC) is a rare type of malignant tumor, accounting for about 1% of all salivary gland tumors arising most commonly in the parotid gland, but it has also been described in the submandibular gland as well as in minor salivary glands and palate. A biphasic cell arrangement formed by an inner layer of duct-forming epithelial cells and an outer layer of myoepithelial cells is the histological hallmark

Herein, we describe the case of a 44 year old patient diagnosed with an epithelial-myoepithelial carcinoma of the right parotid treated surgically with positive margins, followed by adjuvant radiotherapy; a next generation sequencing showed a HRAS Q61R mutation; three years and a half later he relapsed with lung metastasis treated by surgical excisions along with a platinum based therapy coupled with 5-FU but two years later new lung lesions were seen and the platinum based therapy coupled with 5-FU was adopted again with a stable disease; hence he was started on oral cyclophosphamide for one year; once again, those lung lesions kept on increasing in size and number and once again the platinum based therapy coupled with 5-FU was prescribed but stopped after 6 months for intolerance and major asthenia, and a we decided to stop the treatment . After a median follow up of three years, the disease is always stable and there’s no evidence of loco-regional recurrence.

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