ONCOCASE

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, 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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Succinate dehydrogenase B deficient renal cell carcinoma in a young adult with paraganglioma: Management of a rare, hereditary malignancy

BJMO - volume 15, issue 1, january 2021

D. Hompes MD, PhD, E. Roussel MD, I. Fourneau MD, PhD, M. Albersen MD, PhD, M. Baldewijns MD, PhD, M. Bex MD, O. Bechter MD, PhD, R. Sciot MD, PhD, S. Jentjens MD

SUMMARY

Succinate dehydrogenase deficient renal cell carcinoma (SDH-RCC) is a very rare but distinct renal neo-plasm, most often presenting at a young age and commonly associated with paragangliomas, pheochromocytomas and gastro-intestinal stromal tumours as a hereditary cancer syndrome. Although SDH-RCCs often have a relatively indolent disease course, higher nuclear grade, coagulative necrosis and sarcomatoid dedifferentiation may indicate aggressive disease. Radical surgery and (targeted) radiation therapy are valuable options in the treatment of these rare tumours. Genetic testing for germline SDH mutations is crucial. First-line relatives with germline SDH mutations should undergo periodical screening since early detection is paramount. The strong presence of the Warburg effect in SDH-related tumours make these the hallmark tumour for 18Fluorodeoxyglucose Positron Emission Tomography based screening and follow-up.

(BELG J MED ONCOL 2021;15(1):44-7)

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Tissue is the issue

BJMO - volume 15, issue 1, january 2021

A. Snoeckx MD, JB. Vermorken MD, PhD, M. Kukhalashvili MD, M. Lammens MD, PhD, M. Peeters MD, PhD, P. Specenier MD, PhD, T. van den Wyngaert MD, PhD

SUMMARY

Multimodal therapy, including preoperative chemoradiotherapy followed by total mesorectal excision, has become the standard treatment for patients with locoregionally advanced rectal cancer.1 We report on a 54- year old female patient with rectal adenocarcinoma cT3N0M0, who was treated with neoadjuvant chemo-radiotherapy (capecitabine 825 mg/m² BID 5 days/week + 45 Gy in 25 fractions) followed by total mesorectal excision and adjuvant capecitabine for six months. Eleven weeks after the start of adjuvant capecitabine, she presented with dyspnoea, non-productive cough, shortness of breath, chest wall pain, and decrease of physical activity, for which she was admitted to the Antwerp University Hospital (UZA) in Edegem. Computed tomography (CT) revealed pulmonary emboli, enlarged mediastinal and hilar lymph nodes, and multiple micronodules in both lungs. Radiologic findings were suggestive of metastatic lymph nodules and numerous pulmonary metastases. However, pathological diagnosis showed nude granulomas without necrosis without evidence of tumour. Our case illustrates that sarcoid-like lesions may mimic lung metastases in cancer patients being treated with chemotherapy and that tissue still remains the issue.

(BELG J MED ONCOL 2021;15(1):40-3)

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Limbic encephalitis revealing a small-cell anaplastic lung cancer in a 62-year-old woman with history of breast cancer

BJMO - volume 14, issue 6, october 2020

C-H. Filip , C. Duhem , F. Ries

SUMMARY

Paraneoplastic limbic encephalitis (PLE) is a rare autoimmune neurological syndrome, characterised by the development of neuropsychiatric symptoms and associated with cancer in the absence of tumour cell invasion of the nervous system. PLE is often seen in small-cell lung cancer (SCLC), but can also be found in other cancers, such as breast cancer, thymoma, ovarian teratoma and Hodgkin lymphoma. The course of most PLEs is subacute and symptoms occur before the detection of tumour. The diagnosis of PLE is still mainly based on clinical manifestations and antibody tests, rather than imaging. The identification of specific circulating autoantibodies in patients has revolutionised the diagnosis of PLE and demonstrated immune system involvement.1,2 We present the case of a 62-year old female patient, with history of left sided breast cancer, who presented in 2018 with fatigue, hallucinations, confusion, sleep disorders and anterograde amnesia. Further workup included brain magnetic resonance imaging (MRI) which suggested a diagnosis for limbic encephalitis. Serum and cerebrospinal fluid (CSF) Anti-Hu, anti-Sox1 and anti-Zic4 antibodies were positive. A positron emission tomography – computed tomography (PET-CT) scan revealed two mediastinal lymph nodes and the biopsy of one of them was positive for a small cell carcinoma. In conclusion, paraneoplastic limbic encephalitis occurs at an early stage of the disease development and its detection can therefore lead to an earlier identification of the underlying malignancy and subsequently to a better outcome.

(BELG J MED ONCOL 2020;14(6):293-6)

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A case of a life-threatening toxicity following capecitabine treatment: advocacy for dihydropyrimidine dehydrogenase deficiency screening

BJMO - volume 14, issue 4, june 2020

H. Houssiau MD, L. Duck MD, N. Whenham MD, R. Poncin MD, S. Carlier MD, V. Haufroid PhD, PharmD

SUMMARY

We discuss a life-threatening case of capecitabine toxicity due to the presence of a heterozygous variant on exon 14 (c.1905+1G>A, rs3918290) of the dihydropyrimidine dehydrogenase gene (DPYD). We advocate the need for dihydropyrimidine dehydrogenase deficit screening, which could become mandatory in Belgium, as in France, before any fluoropyrimidine administration to avoid cases of foreseeable toxicity.

(BELG J MED ONCOL 2020;14(4):151–4)

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