Rare metastatic primary intra-abdominal follicular dendritic cell sarcoma poorly responsive to chemotherapy: A case report

Background@#Follicular dendritic cell sarcoma (FDCS) accounts for about 0.4% of soft tissue sarcomas. Approximately onethird of cases occur in extranodal sites and about 28% of extranodal FDCS may metastasize. Intra-abdominal occurrence is rare and there is limited published data to guide oncologists on how to best treat this malignancy.@*Case Presentation@#This is a case of a 33-year-old female who came in due to incidental finding of a left supraclavicular mass with 2-year history of early satiety. Neck node biopsy revealed a poorly differentiated malignant tumor with positive staining for CD21, CD23, vimentin and S100 consistent with FDCS. PET-CT revealed an intensely FDG-avid large mass in the left upper abdomen with signs of necrosis and mass effect. The patient was given three different chemotherapy regimens that included (1) gemcitabine/docetaxel, (2) single agent doxorubicin and (3) ifosfamide/etoposide, but she progressed on all these. Off-label use of bendamustine was then offered and after just the first cycle, the patient reportedly regained strength and was able to get up from wheelchair with noted interval decrease in size of the cervical mass. Unfortunately, the patient deteriorated and succumbed to infection and multiple pulmonary embolisms.@*Conclusion@#Intra-abdominal FDCS is a rare malignancy with heterogenous outcomes with no uniform treatment strategy at present. Molecular tumor board discussion and multi-disciplinary approach in extranodal FDCS is important in the diagnosis and management. Patients with multiple poor prognostic factors are at risk for tumor recurrence, metastasis, and death.

Clinical characteristics and outcomes of coronavirus disease 2019-infected adult cancer patients in the Philippines from March to December 2020

Background@#Data on the clinical characteristics and outcomes of Filipino cancer patients who acquired the coronavirus disease 2019 (COVID-19) are limited and local information is lacking. Here we characterize the outcomes of patients with cancer and COVID-19.@*Methods@#Medical records of Filipino cancer patients with COVID-19 from the University of the Philippines – Philippine General Hospital (UP-PGH), Southern Philippines Medical Center (SPMC), De La Salle – University Medical Center (DLS- UMC), and St Luke’s Medical Center (SLMC) from March to December 2020 were reviewed.@*Results@#Sixty-nine cancer patients were identified to have COVID-19. The mean age was 53 years (range 19-88) and 45 (65%) patients were female. The most prevalent malignancies were from the gastrointestinal tract (16 [23%]) and the breast (14 [20%]). The majority (34 [49%]) had metastatic disease and had a functional status of Eastern Cooperative Oncology Group (ECOG) 2 or worse (39 [57%]). Forty-two (61%) patients had active oncologic treatment given for the past three months and twenty-four (35%) of these patients were on chemotherapy. The most common symptoms upon presentation were cough (34 [49%]) followed by dyspnea (28 [41%]). COVID-19 severity of this series was as follows: 15 mild (22%), 32 moderate (46%), 7 severe (10%), and 15 critical (22%). The majority received intravenous antibiotics (54 [78%]), investigational treatments (27 [39%]), and steroids (20 [29%]). Common complications were acute respiratory failure (20 [29%]), acute respiratory distress syndrome (17 [25]), and septic shock (15 [22%]). At the end of the collection period, 21 (30%) cancer patients died. The mean length of hospital stay was 22 days.@*Conclusion@#Based on the findings of our case series, ECOG 2 and higher, metastatic stage, higher neutrophil to lymphocyte ratio showed a trend to worse outcomes. Cancer-related treatment within the past months did not appear to affect outcomes.