ONCOCASE

Testicular metastasectomy in prostate adenocarcinoma

BJMO - volume 15, issue 7, november 2021

H. Vandeursen MD, PhD, T. Adams MD, T. Van den Mooter MD, X. Mortiers MD

SUMMARY

Prostate cancer (PCa) is the most common cancer in men and the second leading cause of cancer death in men worldwide. Frequent metastatic sites of PCa are bone, lung, liver, pleura and adrenal gland. We hereby present a case of a 70-year old man with a history of prostate adenocarcinoma, treated with external beam radiotherapy, who consulted his urologist with a painful left hemiscrotum. An ultrasound showed a suspicious lesion in his left testis. Pathology of the orchidectomy specimen revealed a metastatic deposit of his prostate adenocarcinoma.

(BELG J MED ONCOL 2021;15(7):380-2)

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Spinal dissemination of glial tumours: Two case reports and review of the literature

BJMO - volume 15, issue 7, november 2021

A. Balland MD, L. Renard MD, N. Whenham MD, P-A. Poncelet MD

SUMMARY

Glioblastoma rarely metastasise outside the brain. Mechanisms of distant dissemination are unclear, therapeutic options limited and prognosis poor. Here we report two cases of glial tumour with a secondary spinal spread. During their follow-up, patients developed neurological symptoms suggestive of a medullary affection. Diagnosis was based on spine MRI with demonstration of intramedullary or leptomeningeal enhancing lesions. Disease rapidly developed with an unfavourable outcome, despite oncological and best supportive treatments. We present a review of the literature focused on spinal dissemination of primary intracranial glioblastoma. We analyse the pathogenesis and the genetic mutations which might be involved. Finally, we discuss symptoms and possible treatments.

(BELG J MED ONCOL 2021;15(7):374-9)

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Repeated stereotactic body radiotherapy (SBRT) in a patient presenting with oligometastatic prostate cancer while treated with anti-androgens: a case report

BJMO - volume 15, issue 6, october 2021

C. Berghen MD, G. De Meerleer MD, PhD, G. Devos MD, H. Dumez MD, PhD, K. Rans MD, M. Bangia , S. Allaert , S. Jentjens MD, PhD, S. Joniau MD, PhD

SUMMARY

This case report of an 80-year-old patient, who presented with up to six manifestations of oligorecurrent prostate cancer (PCa) over a time period of nine years, shows that repeated treatment with metastasis directed therapy (MDT) in this setting is feasible and nearly atoxic.

(BELG J MED ONCOL 2021;15(6):325-30)

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Long-term disease control for an occult small cell carcinoma revealed by a solitary voluminous brain lesion: a case report

BJMO - volume 15, issue 6, october 2021

J. De Man MD, M. Schroeven MD

SUMMARY

A 56-year old female presenting with neurological dysfunction is diagnosed with a voluminous cerebral tumour. After complete resection of the lesion, histopathological examination strongly suggests a metastasis of a small cell lung carcinoma. However, extensive work-up showed no evidence for extracerebral primary tumour. Adjuvant treatment was consistent with radiotherapy and cisplatin-based chemotherapy. After five years the patient is doing well without evidence of recurrence. We present the difficult differential diagnosis between a primary brain small cell carcinoma and an occult small cell lung carcinoma. Extrapulmonary small cell cancer (EPSCC) is a distinct clinicopathological entity compared to SCLC, but because of the low incidence, it is often managed in the same way as SCLC. More clinical knowledge based on retrospective analyses and biological insights is required to determine the best therapeutic approach. In any case, it is important to interpret immunohisto-chemical findings with caution in different clinical situations.

(BELG J MED ONCOL 2021;15(6):321-4)

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Corticosteroids as treatment of viral induced haemophagocytic lymphohistiocytosis in a patient with breast cancer

BJMO - volume 15, issue 4, june 2021

C. Mahiat MD, L. Duck MD, N. Whenham MD, R. Poncin MD, S. Wautier MD, T. Connerotte MD, PhD

SUMMARY

Haemophagocytic lymphohistiocytosis (HLH) is a rare life-threatening disease characterised by cytotoxic immune deregulation leading to hypercytokinaemia and macro-phage activation. Given the high mortality rate, HLH must be suspected in nonspecific situations and promptly confirmed based on 2004-HLH criteria. In adult patients, HLH is usually secondary to infection, malignancy or underlying autoimmune diseases. As treatment, paediatric protocol consists of immuno-therapy and chemotherapy, followed by a haematopoietic stem cell transplant (HSCT). In adults, individualised modified treatment is recommended because of the variable cause and severity of situation. Corticosteroids are the mainstay. We report the case of a patient with breast cancer, for whom we made the diagnosis of HLH during her neoadjuvant chemotherapy based on the 2004-HLH criteria. A viral aetiology was suspected with reactive lymphocytes found on the blood smear, and we promptly initiate treatment of dexamethasone. Our patient fully recovered both from her HLH and breast cancer.

(BELG J MED ONCOL 2021;15(4):186-91)

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A case of HER2-positive breast cancer with rapidly progressing CNS metastases

BJMO - volume 15, issue 3, may 2021

H. Janssen MD, PhD, H. Wildiers MD, PhD, J. Heylen , K. Punie MD, PhD, N. De Moor MD

SUMMARY

A 53-year old woman previously treated for stage IIIc Her2-positive breast cancer presented to the outpatient oncology department with symptoms of holocranial headache irradiating to the neck in combination with morning sickness and vomitus. Brain CT showed multiple cerebellar metastases with signs of tonsillar herniation through the foramen magnum. Since radiotherapy was deemed unsafe given the possibility that transient increase of intracranial pressure could worsen the herniation, urgent treatment with corticosteroids and capecitabine-lapatinib was started. The metastases and peritumoral oedema initially responded well, which allowed subsequent pancranial radiotherapy after three weeks of systemic therapy. We provide a short overview of studies showing that systemic therapy can induce tumour response in brain metastases related to HER2+ positive disease.

BELG J MED ONCOL 2021;15(3):123-7

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Intensified neoadjuvant chemotherapy with SBRT for a borderline resectable pancreatic cancer: A plea for prospective evaluation

BJMO - volume 15, issue 2, march 2021

C. Bouchart MD, J-L. van Laethem MD, PhD, J. Closset MD, L. Mans MD, L. Verset MD, PhD, M. Pezzullo MD, M.A. Bali MD, PhD

SUMMARY

Pancreatic ductal adenocarcinoma (PDAC) is the fourth leading cause of cancer-related death and its 5-year overall survival is poor. Surgery remains the only curative treatment but less than 20% of the patients are resectable at diagnosis. New treatment options for the management of metastatic disease have recently emerged, and with them the question of their use in preoperative strategy. Neoadjuvant sequence may increase the achievement of R0 resection margins in borderline resectable tumours but also the proportion of patients who will receive chemotherapy. We report a case of borderline resectable PDAC treated with duodenopancreatectomy after neoadjuvant treatment consisting of chemotherapy and SBRT.

(BELG J MED ONCOL 2021;15(2):79-82)

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