Metastatic Anaplastic Lymphoma Kinase Rearrangement-Positive Adenocarcinoma of Occult Primary Mimicking Ovarian Cancer.

Lung cancer is a worldwide concern and is the leading cause of cancer-related death in the United States. Adenocarcinoma is the most common type of non-small cell lung cancer; however, unlike other types of lung cancer this disease is often seen in light tobacco smokers and non-smokers. The presence of driver mutations, such as the epidermal growth factor receptor (EGFR) and echinoderm microtubule-associated protein-like 4 (EML-4)-anaplastic lymphoma kinase (ALK) rearrangement, appears to be more common in these patients. The presence of the ALK mutation provides a target for ALK-inhibiting agents, such as alectinib. Routine testing for driver mutations is the standard of care in the management of advanced non-small cell lung cancer. Lung cancer frequently metastasizes to distant sites such as the bone, brain, and the adrenal glands, but rarely to the ovaries. We present a young, female, patient who complained of shortness of breath and was found to have pulmonary emboli, extensive lymphadenopathy, and a right ovarian mass. Initial pathology from a cervical lymph node favored a gastrointestinal or an ovarian malignancy. However, immunohistochemical staining ultimately suggested an occult lung adenocarcinoma primary with ovarian metastasis. She had a left oophorectomy that demonstrated similar findings and was positive for the ALK mutation. She was treated with alectinib with good response though ultimately died from her disease. This case demonstrates the rare finding of an ALK-mutated lung adenocarcinoma with ovarian metastasis and, to our knowledge, it is the first with an occult lung adenocarcinoma primary. Driver mutation testing should be considered in metastasis from an occult primary when a pulmonary malignancy is suspected.

A Novel Treatment With Obinutuzumab-Chlorambucil in a Patient With B-Cell Prolymphocytic Leukemia: A Case Report and Review of the Literature.

We report the case of a patient with B-cell prolymphocytic leukemia who was successfully treated with the novel humanized monoclonal antibody obinutuzumab. This patient was previously treated with the combination of rituximab and bendamustine and had recurrent infusion reactions. Her treatment with rituximab and bendamustine was discontinued when she developed disease progression after 3 cycles of therapy. She was then treated with obinutuzumab 1000 mg on day 1 of every cycle and chlorambucil 0.5 mg/kg on days 1 and 15 every 28 days to which she had greater tolerability. After 4 cycles of treatment, she had resolution of her clinical symptoms, massive splenomegaly, and normalization of her white blood cell count.

Metastasectomy of Solitary Adrenal Metastasis From Small Cell Lung Cancer.

Most extensive-stage small cell lung cancers have disseminated disease at diagnosis, and solitary adrenal metastasis from small cell lung cancer is rare. We report the case of a 51-year-old man with extensive-stage small cell lung cancer with solitary right adrenal metastasis (T2N0M1), who was cured with resection of primary tumor, chemotherapy (cisplatin, etoposide), adrenalectomy, consolidative thoracic radiotherapy, and prophylactic cranial irradiation. He remained cancer free, 7.5 years since diagnosis. For small cell lung cancer with solitary adrenal gland metastasis, metastasectomy combined with chemotherapy and radiotherapy can be curative and enable long-term survival. This treatment approach should be further studied, and similar cases should be reported.

Rituximab Monotherapy in the Management of a Rare Case of an HIV Associated Lymphoproliferative Disorder.

Background. Castleman's disease (CD), also known as angiofollicular node hyperplasia, is a rare heterogenous lymphoproliferative disorder. This disease exists as two distinct entities: a localized or unicentric CD (UCD) which has a more benign clinical course and multicentric CD (MCD) which is a systemic disease and carries a worse prognosis. MCD is often associated with human immunodeficiency virus (HIV) infection and these patients are usually coinfected with human herpes virus-8 (HHV-8). Rituximab is an anti-CD20 monoclonal antibody that has become integral to the management of this disease. It is used alone or in combination with chemotherapy to treat MCD. Case Report. We describe a case of a 58-year-old man with HIV and HHV-8 MCD and evidence of organ failure with a poor performance status that went into complete remission after four cycles of therapy with weekly rituximab. Conclusion. HIV-MCD can be challenging to diagnose and to manage. Early recognition can reduce morbidity and mortality associated with the disease. Rituximab monotherapy can be used as a safe and effective treatment option in patients with a poor performance status.