Case Of Metastatic Lung Cancer Research Articles

Systemic and Oligo-Acquired Resistance to PD-(L)1 Blockade in Lung Cancer.

Clinical patterns and the associated optimal management of acquired resistance to PD-(L)1 blockade are poorly understood. All cases of metastatic lung cancer treated with PD-(L)1 blockade at Memorial Sloan Kettering were reviewed. In acquired resistance (complete/partial response per RECIST, followed by progression), clinical patterns were distinguished as oligo (OligoAR ≤ 3 lesions of disease progression) or systemic (sAR). We analyzed the relationships between patient characteristics, burden/location of disease, outcomes, and efficacy of therapeutic interventions. Of 1,536 patients, 312 (20%) had an initial response and 143 developed AR (9% overall, 46% of responders). OligoAR was the most common pattern (80/143, 56%). Baseline tumor mutational burden, depth of response, and duration of response were significantly increased in oligoAR compared with sAR (P < 0.001, P = 0.03, P = 0.04, respectively), whereas baseline PD-L1 and tumor burden were similar. Post-progression, oligoAR was associated with improved overall survival (median 28 months vs. 10 months, P < 0.001) compared with sAR. Within oligoAR, post-progression survival was greater among patients treated with locally-directed therapy (e.g., radiation, surgery; HR, 0.41; P = 0.039). Fifty-eight percent of patients with oligoAR treated with locally-directed therapy alone are progression-free at last follow-up (median 16 months), including 13 patients who are progression-free more than 2 years after local therapy. OligoAR is a common and distinct pattern of acquired resistance to PD-(L)1 blockade compared with sAR. OligoAR is associated with improved post-progression survival and some cases can be effectively managed with local therapies with durable benefit.

Increased Incidence of Thrombotic Complications With Non-small Cell Lung Cancer Necessitates Consideration of Prophylactic Anticoagulation in Young Individuals.

Venous thromboembolism (VTE) is a common complication in cancer patients and is associated with increased morbidity and mortality. Lung cancer is commonly associated with VTE including pulmonary embolism. We did a retrospective analysis from the 2013 Healthcare Cost and Utilization Project data to determine the role of age as a factor in the development of VTE in this patient group. Patients were selected using the International Classification of Diseases, Ninth Revision (ICD-9) diagnosis codes for metastatic lung cancer and VTE. The patients were stratified by age, sex, race/ethnicity, and site of VTE. There was a total of 16,577 VTE events detected out of a total of 182,863 cases of metastatic lung cancer, representing 9% of the total cases. In patients under 65 years of age, there were 356.82 more cases of pulmonary embolism per 100,000 individuals compared to those older than 65 years (p<0.0001). The same age group also showed 374.83 more upper extremity VTE, 286.94 more non-pulmonary thoracic VTE, and 263.97 more abdominal VTE events per 100,000 individuals (p<0.0001). In conclusion, we found that patients under the age of 65 years had a significantly higher incidence of VTE, pulmonary embolism, upper extremity VTE as well as abdominal and non-pulmonary VTE.

Access to innovative drugs for metastatic lung cancer treatment\xa0in a French nationwide cohort: the TERRITOIRE study

BackgroundTerritorial differences in the access to innovative anticancer drugs have been reported from many countries. The objectives of this study were to evaluate access to innovative treatments for metastatic lung cancer in France, and to assess whether socioeconomic indicators were predictors of access at the level of the municipality of residence.MethodsAll incident cases of metastatic lung cancer hospitalised for a chemotherapy in public hospitals in 2011 were identified from the French National Hospital discharge database. Information on prescription of innovative drugs from an associated database (FICHCOMP) was crossed with the population density of the municipality and a social deprivation index based on national census data.ResultsOverall, 21,974 incident cases of metastatic lung cancer were identified, all of whom were followed for 2 years. Of the 11,486 analysable patients receiving chemotherapy in the public sector, 6959 were treated with a FICHCOMP drug at least once, principally pemetrexed. In multivariate analysis, prescription of FICHCOMP drugs was less frequent in patients ≥66 years compared to those ≤55 years (odds ratio: 0.49 [0.44–0.55]), in men compared to women (0.86 [0.79–0.94]) and in patients with renal insufficiency (0.55 [0.41–0.73]) and other comorbidities. Prescription rates were also associated with social deprivation, being lowest in the most deprived municipalities compared to the most privileged municipalities (odds ratio: 0.82 [0.72–0.92]). No association was observed between the population density of the municipality and access to innovative drugs.ConclusionAlthough access to innovative medication in France seems to be relatively equitable, social deprivation is associated with poorer access. The reasons for this need to be investigated and addressed.

An 8-Mm Polyp Is Worth a 1,000 Words: Metastatic Lung Cancer Within a Tubular Adenoma

Introduction: Lung cancer is the leading cause of cancer deaths in the United States, and cases are often metastatic at the time of diagnosis. We report a case of metastatic lung cancer initially diagnosed incidentally when a metastatic lesion was found within a tubular adenoma. Case Description: A 64-year-old male with thirty pack-year smoking history presented to the hospital with left lower extremity swelling and found to have an extensive unprovoked deep vein thrombosis. He was placed on rivaroxaban. The patient returned to hospital two weeks later with painless hematochezia. Colonoscopy was performed but did not identify a source of bleeding. However, an 8 mm polyp in the sigmoid colon were resected. Pathology results revealed a tubular adenoma containing poorly differentiated adenocarcinoma invading the lamina propria, consistent with pulmonary origin (TTF1 and CK7 positive; CK20, CDX2, GATA3 and S100 negative). Subsequent CT chest/abdomen/pelvis demonstrated multiple spiculated pulmonary nodules and enlarged supraclavicular, cervical, mediastinal and hilar nodes consistent with metastatic lung cancer. Based on the mutation pattern (PD-L1 positive; EGFR/Alk/Ros unmutated), the patient received pembrolizumab as palliative treatment.1538_A Figure 1. Chromogenic photomicrograph of colonic tubular adenoma showing metastatic poorly differentiated adenocarcinoma with negative CDX2 (specific for intestinal epithelium) staining. (x10 magnification)Discussion: Lung cancer is one of the most common primary malignancies with nearly 50% distal metastasis at the time of diagnosis. However, intestinal metastases are considered quite rare. The prevalence of metastasis to GI tract varies by report from 0.5-14%. The most common histologic types are SCC and large cell. Of the potential GI tract metastasis, the most sites are the esophagus, small intestine, and stomach. When colonic metastasis are present, two-thirds of patients are symptomatic at the time of the diagnosis and most commonly describe symptoms of abdominal pain, nausea, vomiting, and weight loss. Metastases to the GI tract are most often encountered during evaluation of symptomatic cases. In the asymptomatic patient they are often found incidentally on imaging or autopsy. Distant metastasis in lung cancer confers poor prognosis. Diagnostic modalities such as colonoscopy likely do not provide mortality benefit but less is known regarding morbidity and prevention of GI complications. In conclusion, lung cancer metastasis to the colon is exceedingly rare, and this is the first reported case of a metastatic lung cancer within a colon polyp.1538_B Figure 2. Chromogenic photomicrograph of poorly differentiated carcinoma showing positive staining for TTF1 (specific for primary lung adenocarcinomas). (x20 magnification)1538_C Figure 3. Spiculated nodular opacity in the left upper lobe anteriorly in an area of focal emphysema measuring 1 cm.

Prophylactic anticoagulation to benefit younger patients under 65 years of age with metastatic lung cancer: An analysis of the 2013 Healthcare Cost and Utilization Project (HCUP) data.

6581 Background: Cancer patients have increased risk of venous thromboses. Venous thromboembolism (VTE) is reported to be a leading cause of death in cancer patients. It has been hypothesized that prophylactic anticoagulation for VTE might improve prognosis and quality of life. Based on our analysis of the 2013 HCUP data, we propose that prophylactic anticoagulation should be considered for patients younger than 65 years with metastatic lung cancer. Methods: Patients were selected using ICD-9 diagnoses codes for metastatic lung cancer and VTE. Diagnoses were stratified by site including upper extremity, lower extremity, pulmonary, abdominal and nonpulmonary thoracic VTE. Patients were stratified by age, sex, race and ethnicity. Differences in incidence of VTE among groups were calculated by the Chi-Square method using the SAS software. Results: There were a total of 16,577 VTE events amongst 182,863 cases of metastatic lung cancer. Subgroup analyses showed that patients younger than 65 years of age had 356.82 more PE events per 100,000 individuals compared to those at or older than 65 years (p &lt; 0.0001). The same age group also showed 374.83 more UE, 286.94 more nonpulmonary thoracic and 263.97 more abdominal (Abd) VTE events per 100,000 individuals (p-values, p &lt; 0.0001). There was no statistically significant difference in the incidence of LE VTE’s between the subgroups. Conclusions: Prophylactic anticoagulation should be considered in patients &lt; 65 years of age with metastatic lung cancer. Increased incidence of VTE in these patients may contribute towards greater morbidity and mortality associated with metastatic lung cancer in this subgroup. [Table: see text]

喀血を主訴とした転移性移行上皮肺癌の 1 例

喀血を主訴とした転移性移行上皮肺癌の 1 例

Expression of hypoxia inducible factor-1α, hypoxia inducible factor-2α and vascular endothelial growth factor in metastatic lung cancer and clinical significance

Objective To discuss the expression patterns of hypoxia inducible factor(HIF)-1α, HIF- 2α and vascular endothelial growth factor(VEGF)in metastatic lung cancer tissues. Methods The immunohistochemical streptavid-in- peroxidase(SP) method was applied to detect the expression of HIF-1α, HIF- 2α and VEGF in 93 cases of surgicall resected metastatic lung cancer, and 57 cases of primary non- small- cell lung carcinoma(NSCLC)as blank control group. Results HIF-1α, HIF-2α and VEGF proteins were expressed in 72 cases of metastatic lung cancer and 58 cases of primary NSCLC with the positive rate being 77.4%, 62.3% and 74.2% respectively(P 0.05). Conclusion HIF-1α, HIF-2α and VEGF expression in lung metastases is increased, and HIF-1α expression was positively correlated with VEGF expression. Key words: Metastatic lung cancer; Hypoxia inducible factor-1α; Hypoxia inducible factor-2α; Vascular endothelial growth factor

A Report of Two Cases of Metastatic Lung Cancer Simulating Gout

Metastatic carcinoma to the foot is a rarely reported event, and may easily be mistaken for more common problems such as acute gout. Furthermore current emphasis on PET scanning for tumor surveillance may not include the distal lower extremities. The author presents two cases of metastatic lung cancer to the distal lower extremity that were initially thought to represent gout.

A rare case of metastatic lung cancer to the bladder.

Cancer metastasis to the bladder from non-contiguous sites is very rare. Lung metastasis to the bladder is even more uncommon, with an extensive literature search identifying only four documented cases in the past 20 years. Of these four cases, only one was from lung adenocarcinoma. In this report, we present the case of a 66-year-old male with known lung adenocarcinoma found to have the incidental finding of a bladder mass upon computed tomography imaging. Histochemical staining of samples from the bladder confirmed metastatic dissemination from the primary lung malignancy.

A rare case of metastatic lung cancer to the bladder

Cancer metastasis to the bladder from non-contiguous sites is veryrare. Lung metastasis to the bladder is even more uncommon, withan extensive literature search identifying only four documentedcases in the past 20 years. Of these four cases, only one wasfrom lung adenocarcinoma. In this report, we present the caseof a 66-year-old male with known lung adenocarcinoma foundto have the incidental finding of a bladder mass upon computedtomography imaging. Histochemical staining of samples from thebladder confirmed metastatic dissemination from the primary lungmalignancy.

同一区域内に腎細胞癌の肺転移と過誤腫を併発した1例

症例は63歳男性．2001年に左腎細胞癌で腎摘除術を施行．術後6年目に肺転移を疑わせる円形で辺縁平滑・境界明瞭な3個の腫瘤が右下葉の同一区域内に出現した．年間1 mm以下と非常に緩徐ではあったが，増大傾向が続いたため，2012年1月に胸腔鏡下右肺部分切除術を行った．病理組織診断の結果，2ヵ所は腎細胞癌肺転移，1ヵ所は肺過誤腫と診断された．経過観察中のtumor doubling timeは肺転移巣が48.1ヵ月と42.0ヵ月，肺過誤腫は41.3ヵ月と計算された．slow growing typeの腎細胞癌肺転移巣では，増大速度が肺良性腫瘍と差がないほど緩徐な場合もあることが確認された．

Nonenhancing Brain Metastases

The hallmark radiological finding in metastatic brain disease is multiple enhancing lesions. We report a case of metastatic lung cancer to the brain with a lack of contrast enhancement. We believe that this unusual finding is due to inadvertent "treatment" of the metastases with the antiangiogenic agent bevacizumab (Avastin).

Metastatic lung cancer involving the vulva: two new cases and literature review

Two new cases of metastatic lung cancer involving the vulva are presented. Metastasis from primary lung cancer is a rare cause of a vulval tumour and may require special immunohistochemical stains to determine whether the vulval tumour is primary or secondary. Awareness of the possibility of metastatic disease involving the vulva is of importance as the patient's prognosis is dependent on an accurate diagnosis and palliative treatment where appropriate.

Metastatic adenocarcinoma after intramedullary fixation of a tibial fracture

We present two cases of metastatic lung cancer which occurred at the site of a previously united tibial fracture. Both patients were treated with a locked intramedullary nail. The patients presented with metastases at the site of their initial fracture approximately 16 and 13 months after injury respectively. We discuss this unusual presentation and review the relevant literature. We are unaware of any previous reports of a metastatic tumour occurring at the site of an orthopaedic implant used to stabilise a non-pathological fracture. These cases demonstrate the similar clinical presentation of infection and malignancy: a diagnosis which should always be considered in such patients.

Metastatic Lung Cancer Diagnosed by Capsule Endoscopy

Results: Case: 71 yo man with intermittent “black” colored stools for several months underwent capsule endoscopy after an unremarkable EGD and a colonoscopy evaluation. He denies any abdominal pain, nausea, hematochezia, and is unaware of any weight loss. Medical history includes diabetes and hyperlipidemia, which he is on the appropriate medications. There is no iron supplementation, but he is on a daily baby aspirin. His family history is negative for IBD and celiac disease. He has a 120 pack-year history of nicotine abuse, but quit 10 years ago. Laboratory evaluation was pertinent for microcytic anemia. Capsule endoscopic exam revealed an ulcer in the distal small bowel. Double balloon enteroscopy and surgery were discussed with the patient after the capsule endoscopy findings. Patient elected laparotomy, and a 9 cm × 4 cm × 2 cm segment of the small bowel was resected. Within the specimen was a 6 cm × 3 cm polypoid, fungating mass. Mass was consistent with high grade, poorly differentiated malignant neoplasm, favoring metastasis as there lacked mucosal dysplasia. Immunohistochemical staining of the neoplasm indicated the primary source to be the lung. CT of the chest revealed a 4 cm mass at the left upper lobe (LUL) with suspicious lymph nodes. Consequently, patient underwent a LUL lobectomy with node sampling, confirming the primary source. Discussion: Small bowel malignancies are rare and account for 0.4% of all cancers. In addition to melanoma, breast, lung, and renal cancers can metastasize to the small bowel by hematogenous spread. Cervical, ovarian, and colon cancers can involve the small bowel by direct extension. In this case, we describe the first case of metastatic lung cancer to the small bowel diagnosed by capsule endoscopy.Figure

ＣＴガイド下針生検後に穿刺経路に転移を認めた転移性肺癌の１例

ＣＴガイド下針生検後に穿刺経路に転移を認めた転移性肺癌の１例

空洞内腔を観察し得た転移性肺癌の 1 例

空洞内腔を観察し得た転移性肺癌の 1 例

CLINICAL REAPPRAISAL OF SCALEN NODE BIOPY WITH VARIOUS INTRATHORACIC DISEASES

Scalene node biopsy (SNB) has been utilized for diagnostic and/or staging purposes in various primary and metastatic chest diseases. In this clinicopathological study, SNB was reassessed with regard to its indication and diagnosis. During the period between 1961 and 1983, 99 patients with chest diseases received SNB at our institution. The diagnosis prior to SNB consisted of 84 cases of primary lung cancer, 4 cases of metastatic lung cancer, 3 cases of mediastinal tumor and 8 cases of sarcoidosis. Satisfactory specimens were obtained from 94% of these patients and the complication rate was only 2%. Among benign thoracic lesions, sarcoidosis is best indicated for SNB. It can be diagnosed 100% accurately if adequate specimens are provided, preferably from the right side. It was diagnostic in 35% of the primary lung cancer cases. The accuracy rates were 65% for adenocarcinoma, 12% for squamous cell carcinoma and 50% for small cell carcinoma, respectively. Palpable scalene turned out to be 100% positive for metastases, while only 16% of nonpalpable nodes were proved to contain carcinoma. This study suggests that indication of SNB should be individualized.

The cellular basis of metastatic bone disease in patients with lung cancer.

Histologic patterns of tumor-bone interaction were systematically evaluated in 80 cases of metastatic lung cancer involving bone. Patterns of tumor-bone interaction varied with the histologic type of lung cancer, reflecting the biochemical and biologic differences among the different types of lung cancer. Evidence presented here suggests that destruction of bone by metastatic lung cancer is mediated neither by direct contact of tumor cells with bone matrix nor by release of diffusible substances that lyse bone matrix. Among indirect mechanisms, the most prevalent and important was the activation of bone-lining cells by metastatic tumor. Epidermoid carcinomas in particular were associated with histologic patterns of classical bone remodelling, including osteoblastic, osteoclastic, and osteocytic activity. Adenocarcinomas showed a particularly high association with microfractures and manifested a stromal pattern consistent with release of prostaglandins. Ischemic necrosis of bone due to compression of vessels by expanding tumor mass is also a common and important mechanism. Correlation of histologic patterns with reported data on the frequency of metastases and syndromes of ectopic hormone production provides insight into the mechanism(s) of paraneoplastic hypercalcemia in patients with lung cancer.

Criteria for the Histologic Diagnosis of Bronchogenic Carcinoma

SUMMARY 1.Cumulative reports have established that bronchogenic carcinoma may be simulated, histologically, by bronchial, lung and lymph node metastases from extrathoracic carcinomas. 2.A necropsy study of 124 cases of bronchogenic carcinoma and 224 cases of metastatic lung cancer revealed that histologic differentiation was not always feasible. 3.The definitive criteria for the diagnosis of squamous cell and oat-cell carcinoma consisted of (a) demonstration of the site of epithelial origin and (b) exclusion of features indigenous to metastatic tumors. 4.The histologic resemblance of peripheral metastases to adenocarcinoma precluded a positive diagnosis of primary lung cancer without necropsy. 5.The characteristic features of metastatic bronchial carcinoma in the early stages were involvement of the subepithelial lymphatics and preservation of the epithelium. 6.Pulmonary metastases from extrathoracic ductal or glandular carcinomas often presented as squamoid tumors containing few identifiable ductal structures. 7.Pulmonary metastases from extrathoracic squamous cell carcinomas usually showed a higher degree of keratinization and pearl formation than the primary squamous cell carcinomas of the lung. 8.A definitive clue to the diagnosis of metastatic tumors was the presence of cells typifying the site of origin. 9.The presence of carcinomatous emboli in the small arteries occurred predominantly in the cases of metastatic lung cancer. 10.Lymph node invasion presented problems in differential diagnosis because of the pleomorphic features of extrathoracic metastases and the simulation of oat-cell carcinoma by lymphosarcoma.