I****a
发帖数: 407 | 1 1. 65 y/o white female with PMH/PSH of DM, stage 2 endometrial cancer in
1990, S/P TAH/BSO who presented with a rib fracture after bicycle accident.
Her chest x ray identified a round 2 cm nodule of right upper lobe
suggestive of primary lung cancer. She is not a smoker. Her PET CT showed
uptake of that nodule, no other abnormality. The nodule is not accessible by
CT guided biopsy so the decision was to take her to OR for lobectomy if
frozen shows lung cancer. To our surprise, the nodule is turned out to be
metastatic endometrial cancer, well differentiated and 100% ER/PR positivity
. Patient did well after surgery and she is cancer free for 1 year + so far.
The longest latency of endometrial cancer recurrence was reported in Japan
with 27 years. Our case is 21 years. In general, those patient with single
or oligo pulmonary metastasis do very well after metastasectomy.
2. A follow up case I saw just 2 days ago.
64 y/o female with PMH/PSH of stage 1 renal cell carcinoma in 2000, S/P
nephrectomy, she presented in ER 8 months ago with chest pain and CT
angiogram was done which showed 4 highly vascularized pancreatic lesions.
Subsequent EUS guided needle biopsy demonstrated classic renal cell
carcinoma. Her primary oncologist has followed her almost yearly with CT
scan and to my knowledge her last scan was in 2009 and it was clean of any
pancreatic lesion. She was placed on Sutent ( VEGF tyrosine kinase inhibitor
) and her repeated scan showed partial response. She has been doing really
well but starting from 1 month ago she started having episodic near fainting
episode, extreme weakness although symptoms will resolve after she drinks
juice. This case is very interesting. Firstly, renal cell cancer is known to
selectively metastasize to pancreas and the most of them have a very long
dormancy with average of 10 years. Why it likes pancreas? Nobody knows, it
is not explained by anatomy at least. Secondly, this patient has Whipple's
triad suggestive of hyperinsulinemia and RCC pancreatic met is reported
causing islet cell hyperplasia. So we are giving this patient a glucometer
to document the hypoglycemia and if that is case we will then refer her to
endocrinologist. | A*******s
发帖数: 9638 | 2 Ding first. Will be back later. | A*******s
发帖数: 9638 | 3 These 2 cases are great.
Case 1 speaks enough for the importance of past medical history.
Case 2. Pretty much same thing. Two comments:
a). RCC mets to pancrease is rare. But it happens. I guess it has something
to do with anatomy. They are all retroperitoneal organs.
b)." RCC pancreatic met is reported causing islet cell hyperplasia."
This is interesting. If it is the case, the treatment should focus on mets
not the islet cell hyperplasia, right? So I wonder what endocrinologists can
help you?
这两个例子证实了中国人的一句老话： 问题永远是问题。 | I****a
发帖数: 407 | 4 You are right. The concern I have is that this patient developed what it
seems to be hypoglycemia with tumor been shrinking by Sutent. I wonder
whether she might need other form of therapy, such as Glucagon injection in
the event of emergency. | A*******s
发帖数: 9638 | 5 Maybe againstwind can answer your questions. :)
in
【在 I****a 的大作中提到】
: You are right. The concern I have is that this patient developed what it
: seems to be hypoglycemia with tumor been shrinking by Sutent. I wonder
: whether she might need other form of therapy, such as Glucagon injection in
: the event of emergency.
| J******s
发帖数: 7538 | 6 Thanks for your sharing.:-)
For the second case, there are some similar reports.
Is pancreatic resection necessary?
.
by
positivity
far.
【在 I****a 的大作中提到】
: 1. 65 y/o white female with PMH/PSH of DM, stage 2 endometrial cancer in
: 1990, S/P TAH/BSO who presented with a rib fracture after bicycle accident.
: Her chest x ray identified a round 2 cm nodule of right upper lobe
: suggestive of primary lung cancer. She is not a smoker. Her PET CT showed
: uptake of that nodule, no other abnormality. The nodule is not accessible by
: CT guided biopsy so the decision was to take her to OR for lobectomy if
: frozen shows lung cancer. To our surprise, the nodule is turned out to be
: metastatic endometrial cancer, well differentiated and 100% ER/PR positivity
: . Patient did well after surgery and she is cancer free for 1 year + so far.
: The longest latency of endometrial cancer recurrence was reported in Japan
| f******w
发帖数: 10267 | 7 WOW! The warmest welcome! My bad, I only knew you were a talented poet.
【在 J******s 的大作中提到】
: Thanks for your sharing.:-)
: For the second case, there are some similar reports.
: Is pancreatic resection necessary?
:
: .
: by
: positivity
: far.
| b******a
发帖数: 704 | 8 Here are some links about this topic. Thanks for sharing such an interesting case!
1. World J Gastroenterol. 2011 November 21; 17(43): 4747–4756.
Pancreatic metastases from renal cell carcinoma: The state of the art
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3229623/
"Tumor cells apparently have a high affinity for the parenchyma of the pancreas and only there do they find the conditions they need to mature to manifest metastases. The high affinity of some renal cancer cells for the parenchyma of the pancreas is supported by some reports[23] of metachronous late metastases which again occurred solely in the residual pancreas[11,22]. The results of basic research, which is slowly unraveling the local biochemical mechanisms that underlie the development of metastases, are promising, so it is hoped that the biochemical causes of the unique spreading pattern of some RCC will perhaps be understood one day[29]."
2. Pancreatic metastasis from renal carcinoma managed by Whipple resection.
A case report and literature review of metastatic pattern, surgical
management and outcome.
http://www.ncbi.nlm.nih.gov/pubmed/19581746
【在 J******s 的大作中提到】
: Thanks for your sharing.:-)
: For the second case, there are some similar reports.
: Is pancreatic resection necessary?
:
: .
: by
: positivity
: far.
| I****a
发帖数: 407 | 9 Thanks for the link. Cancer therapy has changed so much in recent years.
Almost every couple weeks, new practice changing therapy is brought to day
light. For someone who is interested in oncology, I feel the excitement is
just beginning.
Happy New year, comrades! | b******a
发帖数: 704 | 10 Happy Chinese New Year!
Here is what I recently read online. Very interesting topic from MAYO CLINIC !
PUBLIC HEALTH RELEVANCE: Clear cell renal cell carcinoma (ccRCC) is the most
lethal form of kidney malignancy, killing nearly 13,000 patients annually.
Current treatment options for metastatic ccRCC are limited as evident in 2
year survival rates of 10-20%. Advancing ccRCC patient care centers around
several areas including better methods for identifying patients at high risk
for metastatic relapse following surgery, more thorough understanding of
molecular mechanisms that drive ccRCC metastatic progression, and developing
rational mechanism-targeted therapies to treat metastatic ccRCC disease. We
have determined that ccRCC tumors can aberrantly express several relatively
novel immune cell coregulatory ligands, namely B7-H1, B7-H3, and B7-H4, the
expression of which predict aggressive ccRCC behavior and increased cancer-
related death. These observations raise the distinct possibility that human
tumors, especially ccRCC, might employ B7-H ligands to blunt patients' anti-
tumor immune responses, thereby promoting malignant progression. Tumor-
associated B7-H ligands may likely prove useful to refine prognostic
algorithms to pinpoint high-risk patients who are most prone to ccRCC
progression and death. However, whether tumor-associated B7-H ligands
actually function as clinical inhibitors of cell-mediated antitumoral
immunity to promote malignant progression remains to be determined, as does
the rationale for B7-H blockade as immunotherapeutic means to improve
treatment of advanced ccRCC (or any other malignancy for that matter). This
proposal is singularly devoted to studies that, we believe, will directly
improve clinical ccRCC patient care. Specifically, our studies will
rigorously test the prognostic and immunotherapeutic potential of B7-H
ligands aberrantly expressed by ccRCC. Specifically, we will address a most
vital question: "Do B7-H ligands within clinical tumors truly function to
impair antitumoral immunity in cancer patients?" Such findings will help to
establish the merits (and limitations) of in vivo B7-H ligand blockade as a
clinical immunotherapeutic approach to treat human forms of malignancy.
day
is
【在 I****a 的大作中提到】
: Thanks for the link. Cancer therapy has changed so much in recent years.
: Almost every couple weeks, new practice changing therapy is brought to day
: light. For someone who is interested in oncology, I feel the excitement is
: just beginning.
: Happy New year, comrades!
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