ABSTRACT
BRAF mutations occur in about 3% of all lung adenocarcinomas and V600E missense mutation characterizes about half of BRAF-mutated lung adenocarcinomas and is significantly associated with micropapillary pattern and shorter disease-free and overall survival rates. In this report, we report a challenging case of a patient with a metastatic micropapillary adenocarcinoma of the lung harbouring V600E BRAF mutation who experienced a surprising protracted clinical response to metronomic vinorelbine. The possible association between the V600E BRAF mutation pathway and the effective use of vinca alkaloid is discussed.
Subject(s)
Adenocarcinoma of Lung/diagnosis , Breast Neoplasms/diagnosis , Lung Neoplasms/diagnosis , Proto-Oncogene Proteins B-raf/genetics , Adenocarcinoma of Lung/genetics , Adenocarcinoma of Lung/secondary , Aged, 80 and over , Antineoplastic Agents, Phytogenic/pharmacology , Breast/pathology , Breast Neoplasms/genetics , Breast Neoplasms/secondary , Female , Humans , Lung Neoplasms/genetics , Lung Neoplasms/pathology , Mutation, Missense , Neoplasm Metastasis , Vinorelbine/pharmacologyABSTRACT
We present a case of epithelioid hemangioendothelioma metastatic to pleura, in a 69-year-old woman with chest pain. This distinctive vascular neoplasm can arise in various organs, most commonly in middle-aged women. It is characterized by slow growth, and, microscopically, by epithelioid tumor cells in appearance. Epithelioid hemangioendothelioma should be distinguished mainly from primary or metastatic carcinomas and angiosarcoma. Definitive diagnosis often requires immunohistochemistry. Its clinical course is unpredictable, although survival rates are better than for angiosarcoma.
Subject(s)
Hemangioendothelioma, Epithelioid/secondary , Mediastinal Neoplasms/pathology , Pleural Neoplasms/secondary , Aged , Biomarkers, Tumor/analysis , Female , Hemangioendothelioma, Epithelioid/metabolism , Humans , Immunohistochemistry , Mediastinal Neoplasms/metabolism , Pleural Neoplasms/metabolismABSTRACT
Pre-clinical data suggest a relationship between DNA MisMatch Repair (MMR) system failure, particularly the inactivation of genes hMLH1 and hMSH2, and resistance to drugs like cisplatin and carboplatin. We studied the correlation between loss of hMLH1 expression in tumour cells and clinical outcome in 38 patients with ovarian cancer, who underwent cisplatin-based chemotherapy. 19 patients (56%) showed loss of hMLH1 expression (Group A) while 15 patients (44%) showed normal hMLH1 expression (Group B). 4 patients were not evaluable for hMLH1 expression. The 2 groups of patients were similar for clinical characteristics, response to chemotherapy and time to progression. Group A patients showed a median survival of 55 months whereas Group B patients had a median survival of 12 months (P=0.014). Loss of hMLH1 expression was the only independent predictor of survival in the multivariate analysis. Our observations suggest a relationship between loss of hMLH1 and improved survival in advanced ovarian cancer.
