Follow-Up of Patients Diagnosed With Germinal Testicular Tumors (Seminomas and Non-seminomatous) Treated With a Bone Marrow Transplant and a High Dose of Chemotherapy.

INTRODUCTION: Germinal testicular tumors are the most common malignant neoplasm in men around 20 to 34 years. Even though they are unusual, they have increased incidence in the last decade; they have an excellent prognosis and overall survival at five years, approximately 95%. Divergent data exists regarding treatment options in patients with first, second, and third relapses with conventional therapy. Some studies describe the possible benefit of using high-dose chemotherapy associated with a bone marrow transplant with variable results. METHODS:  The present study describes clinical outcomes, clinical response, mortality, overall survival, and progression-free survival to two years in a group of patients with germinal malignant tumors, seminoma versus non-seminomatous with evidence of progression of the disease at first, second, or third conventional chemotherapy regimens, and who received high dose chemotherapy and bone marrow transplantation at the National Cancer Institute between 2010 and 2021. RESULTS: A retrospective observational study of case series showed that 57% of patients in third-line therapy received high-dose chemotherapy and bone marrow transplantation, with progression disease median time from diagnosis more than two years. Patients in the post-graft period presented infectious complications (71%). The most common were febrile neutropenia (29%) with a mortality rate of 71% (n=5), progression-free survival of 2.3 months, and overall survival of 7.4 months. CONCLUSIONS:  These results show that in this group of patients, regimens with high-dose chemotherapy associated with bone marrow transplants, have a worse prognosis compared to other cohorts of patients, and may not be the best candidates for this rescue therapy.

A Retrospective Study of Metastatic Renal Cell Carcinoma Patients With Brain Metastases.

Metastatic renal cell carcinoma (mRCC) involving the central nervous system is currently an excluded subgroup of patients in the systemic treatment; for this reason, there is no solid data to support the efficacy of therapies in this subgroup. That is why it is important to describe real-life experiences in order to know if there is a special change in clinical behavior or treatment response in these kinds of patients. Patients and methods A retrospective review was performed to characterize mRCC patients diagnosed with brain metastases (BrM) during treatment at the National Institute of Cancerology of Bogota, Colombia. Descriptive statistics and time-to-event methods are used to evaluate the cohort. For the descriptive measures of quantitative variables, the mean with standard deviation was taken, and the minimum and maximum values were reported. In the case of qualitative variables, absolute and relative frequencies were used. The software used was R - Project v4.1.2 (R Foundation for Statistical Computing, Vienna, Austria). Results A total of 16 patients were included with mRCC between January 2017 to August 2022 with a median 35.1-month follow-up, 4/16 (25%) were diagnosed with BrM at the time of screening and 12/16 (75%) during treatment. The International Metastatic RCC Database Consortium risk (IMDC) was favorable for 12.5%, intermediate for 43.7%, and poor for 25%, and not classified for 18.8%, BrM involvement was multifocal in 50% of the population and localized, brain-directed therapy was done in 43.7% of patients, predominantly palliative radiotherapy. Median overall survival (OS) for all the patients regardless of the time of metastatic presentation of the disease in the central nervous system was 53.5 months (0-70.3), and OS for cases with central nervous system involvement was 10.9 months. IMDC risk did not correlate with survival (log-rank, p=0.67). The OS for the subgroup of patients who debut with metastatic disease in the central nervous system is different from the group that developed metastasis in the progression of their disease (OS of 42 vs 3.6 months, respectively). Conclusions This is the largest descriptive study in Latin America and the second in the world from one institution that admits patients with metastasic renal cell carcinoma and central nervous system metastasis. In these kinds of patients with metastatic disease or progression to the central nervous system, there is a hypothesis that shows more aggressive clinical behavior. There is limited data on locoregional intervention to metastatic disease in the nervous system drastically, but trends show this could impact overall survival outcomes.

Bone Metastasis From Glioblastoma Multiforme: A Case Report.

Glioblastoma multiforme (GBM) is the most frequent neoplasm of the central nervous system (CNS) with a low incidence in people. The heterogeneous characteristics of this malignant tumor make the overall survival one of the shortest. Metastatic lesions due to glioblastoma are mainly reported in liver, lungs and leptomeningeal spaces, existing in worldwide literature with very few reported cases. The osseous tissue continues to be an exceptional place to present metastases. This is the reason why we report one case of a young adult with extensive lytic compromise confirmed by histopathological features.

Peripheral Neural Sheath Breast Sarcoma: Case Report and Literature Review.

Primary sarcomas of the breast are heterogeneous neoplasms derived from the non-epithelial elements of the mammary gland. Malignant peripheral nerve sheath tumors comprise 5-10% of all malignant soft tissue sarcomas. Its heterogeneity and low incidence (1 in 100,000) limit the performance of prospective studies. Therefore, most published articles include individual reports and case series with a small number of patients, making it impossible to determine clear treatment standards in this scenario. A 36-year-old young woman with no personal history consulted the National Cancer Institute of Colombia with a 1-year progression of a rapidly growing mass in her left breast until reaching an approximate tumor size of 20 × 20 cm. Histopathological analysis with a tru-cut biopsy taken from the lesion revealed the presence of a breast sarcoma with positive staining for SOX-10 and S-100. A radical mastectomy as her first treatment included the resection of a costal arch and, therefore, the reconstruction of the chest wall with coverage of the defect with an extended latissimus dorsi flap followed by consolidation therapy with adjuvant radiotherapy (RT) and chemotherapy. Evidence regarding malignant peripheral nerve sheath sarcoma of the breast treatment corresponds to retrospective analyses and case reports with high heterogeneity and variability about strategies in surgical procedures and adjunctive therapy such as complementary chemotherapy and RT; therapeutic approach should always include a multidisciplinary team.

Two Unusual Mutations in the Epidermal Growth Factor Receptor Gene in a Patient With Lung Adenocarcinoma.

Adenocarcinoma (ADC) of the lung is the most frequent pathology corresponding to non-small cell lung cancer (NSCLC). The advent of target therapy and the discovery of drugs that block signaling pathways related to cellular events involved in the progression of the disease have led to a better prognosis in cases of ADC. Some of the targeted therapy focuses on the blockade of epidermal growth factor receptor (EGFR), targeting mutations in exon 19 and 21, with favorable clinical outcomes. However, there is limited evidence with respect to unusual mutations as in exon 18 (g719x) and 20 (s768). In this report, we present a case of a 65-year-old female with two unusual mutations in the EGFR gene, in exon 18 (g719x) and 20 (s768i), without central nervous system (CNS) involvement; these mutations are typically resistant to standard therapy. We decided to administer osimertinib because of its favorable toxicity profile and with a view to preventing future CNS relapse.

Adamantinoma Presenting With Local Recurrence and Inguinal Lymph Node Metastasis: A Case Report.

Adamantinoma of long bones is a slow-growing, low-grade primary malignant bone tumor. It is a rare entity and accounts for less than 1% of all primary bone tumors, and in most cases, it occurs in the mid-axis of the tibia of adolescents and young adults. In this report, we describe the case of a 53-year-old woman with a diagnosis of adamantinoma of the left tibia who was initially treated surgically in 2004. Two years later, she presented with local relapse, for which she underwent new surgical management. The patient was referred to our practice 16 years after the initial diagnosis, and she presented with recurrence characterized by ipsilateral inguinal lymph node metastasis. The histological findings and immunohistochemistry were compatible with metastatic adamantinoma with high-grade differentiation, which ultimately required surgical salvage management.

Concurrent Chemoradiation for Mediastinal Oligometastases From Cervical Cancer: A Potentially Curative Treatment.

Currently, the standard treatment for women with metastatic cervical cancer is palliative chemotherapy with or without bevacizumab. Patients with oligometastatic disease seem to have a better prognosis than those with disseminated disease. We present two cases of women with mediastinal oligometastatic disease from cervical cancer treated with mediastinal radiotherapy concurrent with intravenous cisplatin. Both patients achieved a complete response that remained after a follow-up of more than three years.

Neurofibromatosis Type 1 - Association with Breast Cancer, Basal Cell Carcinoma of the Skin, and Low-Grade Peripheral Nerve Sheath Sarcoma: Case Report and Literature Review.

Neurofibromatosis type 1 is a rare medical condition that raises the probability of having distinct types of malignant and benign neoplasms. Nevertheless, the association with breast cancer is rare, and metachronic neoplasia with a distinct histologic subtype is an association that has never been reported before. Here we describe a case of a primary breast tumor, with posterior development of basal cell carcinoma of the skin, and a low-grade peripheral nerve sheath sarcoma.

Primary Gastrointestinal Kaposi's Sarcoma in a Patient with Human Immunodeficiency Virus.

Gastrointestinal bleeding in HIV patients secondary to coinfection by HHV8 and development of Kaposi's sarcoma (KS) is a rare complication even if no skin lesions are detected on physical examination. This article indicates which patients might develop this type of clinical sign and also tries to recall that absence of skin lesions never rules out the presence of KS, especially if gastrointestinal involvement is documented. Gastrointestinal bleeding in terms of hematemesis has rarely been reported in the literature. We review some important clinical findings, diagnosis, and treatment approach. We present the case of an HIV patient who presented to the emergency department with hematemesis and gastrointestinal signs of KS on upper gastrointestinal endoscopy without any dermatological involvement.

High-Grade Left Atrial Pleomorphic Sarcoma: Case Report and Review.

Primary pleomorphic sarcoma of the left atrium is a rare tumor. There is no actual evidence of the management of this pathological entity, so the main treatment is individualized, surgical management being the cornerstone of the treatment. We present a 78-year-old female who had a clinical picture of heart failure, documenting an atrial mass of the left atrium, with high-grade pleomorphic sarcoma revealed in histopathology. The tumor was surgical removed, with no clinical evidence of residual mass. The tumor recurred again within 3 years, to which the patient succumbed.