ONCOCASE

5-Fluorouracil-induced coronary vasospasm: case report and discussion

5-Fluorouracil is one of the most widely used chemotherapeutic agents. It has been included in the treatment of a number of solid tumours, including upper gastrointestinal, colorectal and breast cancer, for many years. It is the backbone of several chemotherapy regimens, particularly in the treatment of gastrointestinal tract adenocarcinomas. Unfortunately, cardiotoxicities may be expected to occur regularly. As 5-fluorouracil is widely used, cardiotoxicity due to 5-fluorouracil is a relatively common problem. The case of a 64-year old man with invasive intestinal adenocarcinoma, who developed chest pain during his first mFOLFOX cycle, is presented. We see in this case and in the literature that recurrence of cardiac toxicity is high, even with premedication. There is some evidence that replacing the fluoropyrimidine by raltitrexed is safe and efficacious for patients with 5-fluorouracil (cardiac) toxicity in the setting of colorectal cancer.

(BELG J MED ONCOL 2015;9(5):194–98)

Incidental finding of prostate cancer in patients treated with benign prostatic hyperplasia (BPH)

In this case report we describe the incidental finding of prostate cancer in a patient undergoing a transurethral prostate resection for benign prostatic hyperplasia and discuss the diagnostic and treatment approach of this patient group.

(BELG J MED ONCOL 2015;9(3):104–6)

Angioedema of the tongue in a patient with breast carcinoma treated with exemestane-everolimus in combination with an angiotensinconverting enzyme inhibitor

This report describes the case of a patient with metastatic breast cancer that was treated with exemestaneeverolimus and who developed unilateral angioedema of the tongue as an adverse effect due to the combination of everolimus and an angiotensin-converting enzyme inhibitor. Since high doses of everolimus are used in the treatment of more common malignancies such as advanced renal cell and breast cancer, an increase in the occurrence of this potentially severe adverse effect can be expected. We recommend carefully looking into the current medication list of the patient before starting everolimus and when an angiotensin-converting enzyme inhibitor is present, it should be replaced by an alternative antihypertensive drug until more data become available. That way treatment discontinuation or dose reduction of anticancer treatment can be avoided.

(BELG J MED ONCOL 2015;9(2):71–3)

Mixed adenoneuroendocrine carcinoma (MANEC) of the colon: molecular pathogenesis and treatment

We present the case of a 30-year-old male patient with a high grade neuroendocrine carcinoma and an adenocarcinoma developed in a tubulovillous adenoma of the colon, with diffuse liver metastasis. He underwent a right hemicolectomy and received four courses of postoperative chemotherapy with cisplatin and etoposide, followed by high dose chemotherapy with autologous stem cell support. After this treatment there was a complete biochemical and radiological remission. Now, 48 months after diagnosis the patient is alive and in unmaintained complete remission. The occurrence of a high grade neuroendocrine carcinoma in a low grade colon adenocarcinoma without any intermediate phenotypes was intriguing. Comparative exome sequencing of DNA from the malignant components revealed six somatic changes in cancer consensus genes. In both tumours, we detected mutations in APC and KRAS, as well as in BCL9 and FOXP1. Only in the neuroendocrine carcinoma component did we find a mutation in SMARCA4. All mutations were absent in germ-line DNA. The finding of several identical somatic mutations in both components in the subsequent exome sequencing supports a clonal relationship between the neuroendocrine carcinoma and the synchronous adenocarcinoma. We suggest that a mutation in SMARCA4A may be responsible for the abrupt transition to the aggressive neuroendocrine phenotype.

(BELG J MED ONCOL 2015;9(1):31–34)

Resection of two metachronous solitary pulmonary metastases of prostate cancer after radical prostatectomy: an exceptional case

A solitary pulmonary metastasis of prostate cancer is not considered a surgical lesion. However, growing evidence supports that highly selected patients could benefit from metastasectomy of a solitary pulmonary metastasis. We present an exceptional case of resection of two metachronous pulmonary metastases of prostate cancer after previous radical prostatectomy, resulting in nearly undetectable prostate-specific antigen (0.04 ng/ml).

(BELG J MED ONCOL 2014;8(5):217–9)

Subcutaneous panniculitis-like T-cell lymphoma in an elderly patient: a case report

We report a case of subcutaneous panniculitis-like T-cell lymphoma in an 84-year old woman admitted to the geriatric ward presenting with fever, loss of appetite and indurated lesions on the legs. Time from admission to diagnosis was seven weeks. Time from onset of first symptoms to diagnosis was four months. She was treated with systemic steroids with a good clinical response.

(BELG J MED ONCOL 2014;8(4):125–8)

Oligometastatic ovarian cancer successfully treated with stereotactic radiotherapy

A 53-year old woman presented with an ovarian cancer, FIGO stage IIIc, for which she received a (suboptimal) debulking. Chemotherapy was started, consisting of three-weekly carboplatin-paclitaxel. After four cycles, an interval-debulking was done, which revealed one positive lymph node (out of 21) located interaortocaval. Chemotherapy was resumed, until seven cycles. She had a complete remission, but after four years, she developed positive mediastinal and interaortocaval lymph nodes. She was treated with stereotactic radiotherapy, which resulted in resolution of the lesions and normalisation of the tumour marker. She has no signs of relapse after nearly two years.

This case illustrates that radiotherapy can be an important treatment option in selected patients with oligometastases.

(BELG J MED ONCOL 2014;8(3):87–90)