Metastatic Pulmonary Carcinoma Research Articles

Metastatic pulmonary neuroendocrine carcinoma associated with AVP deficiency and panhypopituitarism due to a hypothalamic metastasis

Metastatic pulmonary neuroendocrine carcinoma associated with AVP deficiency and panhypopituitarism due to a hypothalamic metastasis

Ultrasonographic Renal Subcapsular Thickening in Cats with Primary and Metastatic Carcinoma.

Ultrasonographic subcapsular thickening caused by renal neoplasia other than lymphoma has been previously reported in cats; however, detailed information is lacking. This study aims to describe ultrasonographic findings in renal subcapsular thickening and renal parenchyma in cats diagnosed or presumed with primary and metastatic carcinoma in the kidney. Ultrasound reports were retrospectively searched from 3 veterinary hospitals and 6 cats with 9 affected kidneys were included. Renal lesions were confirmed either cytologically or histopathologically as primary renal carcinoma with metastasis in the contralateral kidney (in 1 case), or metastatic pulmonary carcinoma (in 3 cases). Two patients were cytologically diagnosed with pulmonary carcinoma with concurrent renal subcapsular thickening. Eight kidneys affected by metastatic carcinomas showed relatively thin, focal, and homogeneously hypoechoic subcapsular thickening while a single kidney affected by primary renal carcinoma showed markedly thick, circumferential, and heterogeneously mixed iso- to hypoechoic lesion. The renal parenchyma, especially when just beneath the subcapsular lesion, exhibited at least one abnormality in all affected kidneys, most characterized by hyperechoic renal cortex with concurrent hypoechoic striations. This is the first report describing metastatic carcinoma causing renal ultrasonographic subcapsular thickening in cats. Our results suggest that renal carcinoma should be included in differential diagnoses when ultrasonographic subcapsular thickening is present in cats.

73P Camrelizumab plus famitinib as first-line treatment in patient with locally advanced or metastatic pulmonary sarcomatoid carcinomas (CAPSTONE): A multi-center, single-arm, phase II study

73P Camrelizumab plus famitinib as first-line treatment in patient with locally advanced or metastatic pulmonary sarcomatoid carcinomas (CAPSTONE): A multi-center, single-arm, phase II study

Histological and immunohistochemical features of carcinomas with pulmonary involvement in cattle.

Primary pulmonary neoplasms in cattle are rare. There are few studies on the pathological findings of these neoplasms in this species. This study aimed to describe the histological and immunohistochemical findings of primary and metastatic pulmonary carcinomas in cattle. We conducted a retrospective study of 19 cases of epithelial neoplasms with pulmonary involvement. Histologically, most of the neoplasms were classified as primary pulmonary neoplasms, including different adenocarcinoma subtypes (4/19, 21%) and adenosquamous carcinomas (3/19, 16%), followed by squamous cell carcinoma (6/19, 32%), metastatic uterine adenocarcinoma (4/19, 21%), metastatic hepatocellular carcinoma (1/19, 5%), and metastatic cholangiocarcinoma (1/19, 5%). By immunohistochemistry, all neoplasms were positive for pancytokeratin, and 4/19 (21%) were positive for vimentin. Primary pulmonary neoplasms had immunoreactivity for thyroid transcription factor-1 (6/7), while only 2 of these cases were positive for napsin A. All cases with squamous differentiation (9/9) had immunoreactivity for cytokeratin (CK) 5/6, while only 7 of these cases were positive for p40. CK20, CK7, and CK8/18 showed varied immunoreactivity in the primary and metastatic pulmonary carcinomas but were important markers to confirm the diagnosis of primary mucinous adenocarcinoma and metastatic cholangiocarcinoma. HepPar-1 was only positive in the metastatic hepatocellular carcinoma. The limited number of cases of metastatic uterine adenocarcinomas in this study precluded identification of a specific immunophenotype for this tumor. Immunohistochemistry proved to be an important tool to confirm the proper classification of these neoplasms.

Case report of a pan-cytokeratin negative NUT midline carcinoma of pulmonary origin, a BRD3-NUT variant: Challenges in cytomorphologic presentation.

NUT carcinoma is an aggressive malignancy defined genetically by a balanced translocation of the NUT gene on chromosome 15q14, most commonly associated with the bromodomain-containing protein 4 (BRD4) gene on 19p13.1 but less frequently with variant genes, including BRD3 and NSD-3. We present a case report of a metastatic pulmonary NUT carcinoma found to have a BRD3-NUT fusion and to have only focal pan-cytokeratin staining. Biopsy of the pulmonary mass revealed dyscohesive cells with enlarged nuclei, prominent nucleoli and high nuclear to cytoplasmic ratio without areas of squamous differentiation. Initial immunohistochemical stains were positive for NUT, p63 and retained SMARCA4, while negative for Lu-5 (pan-cytokeratin), TTF-1, p40, S100 protein, OCT-4, HMB-45, SMA, and PAX-8. Tempus ×T assay revealed a BRD3-NUTM1 fusion gene. Post-mortem analysis revealed an ill-defined mass abutting the trachea and superior vena cava, as well as a perirenal mass.

PD-1 inhibition plus platinum-based chemotherapy (PBC) or PBC alone in the first-line treatment of locally advanced or metastatic pulmonary lymphoepithelioma-like carcinoma.

BackgroundPulmonary lymphoepithelioma-like carcinoma (PLELC) is a distinctive subtype of non-small cell lung carcinoma that was not well presented in clinical studies. The management of advanced PLELC remains an important, unmet need due to the paucity of high-grade evidence. Herein, we carried out a multicenter, retrospective study to assess the effectiveness and tolerability of PD-1/PD-L1 inhibitor plus chemotherapy versus chemotherapy alone for patients with advanced PLELC in the first-line setting.Patients and MethodsThis retrospective study enrolled patients with advanced PLELC receiving first-line treatment with PD-1 inhibition plus chemotherapy (IO-Chemo group) or chemotherapy alone (Chemo group) in three medical centers in China. The survival outcomes, efficacy, and safety profile were investigated. The primary endpoint was progression-free survival (PFS). Secondary endpoints included objective response rate (ORR), overall survival (OS), and adverse events (AEs).ResultsA total of 133 patients were enrolled. PFS was significantly longer in the IO-Chemo group (median 12.8 months [95% CI 5.2-20.4]) than that in the Chemo group (median 7.7 months [95% CI 6.8-8.6]; hazard ratio [HR] 0.48 [95% CI 0.31-0.74]; P=0.001). ORR was 74.5% (95% CI, 63.0-86.1) in the IO-Chemo group and 34.6% (95% CI, 24.1-45.2) in the Chemo group (P<0.001). The median OS was not reached in the IO-Chemo group versus 35.7 months (95% CI 26.7-44.8) in the Chemo group (HR 0.47 [95% CI 0.20-1.07]; P=0.065). Multivariate analysis revealed that PD-1/PD-L1 inhibitor combination was independently associated with longer PFS (HR 0.40 [95% CI 0.25-0.63]; P<0.001). Grade 3 or higher AEs occurred in 36 (65.5%) patients in the IO-Chemo group and 56 (71.8%) patients in the Chemo group, respectively.ConclusionsIn patients with advanced PLELC, adding PD-1/PD-L1 inhibitor to platinum-based chemotherapy significantly increased PFS and ORR with a tolerable safety profile.

EP08.01-050 Survival Outcome of Metastatic Pulmonary Sarcomatoid Carcinoma Treated with Immunotherapy: An Analysis of National Cancer Database (NCDB)

Pulmonary sarcomatoid carcinoma (PSC) is a rare subtype of non-small cell lung cancer (NSCLC), associated with aggressive disease course, refractoriness to chemotherapy, and poor survival. Excellent response of PSC to immune checkpoint inhibitors were reported in small case reports/series, but it remains unclear whether PSC is still associated with poor prognosis compared to other NSCLC when treated with immunotherapy.

Plasm Metabolomics Study in Pulmonary Metastatic Carcinoma

Background The lung is one of the most common metastatic sites of malignant tumors. Early detection of pulmonary metastatic carcinoma can effectively reduce relative cancer mortality. Human metabolomics is a qualitative and quantitative study of low-molecular metabolites in the body. By studying the plasm metabolomics of patients with pulmonary metastatic carcinoma or other lung diseases, we can find the difference in plasm levels of low-molecular metabolites among them. These metabolites have the potential to become biomarkers of lung metastases. Methods Patients with pulmonary nodules admitted to our department from February 1, 2019, to May 31, 2019, were collected. According to the postoperative pathological results, they were divided into three groups: pulmonary metastatic carcinoma (PMC), benign pulmonary nodules (BPN), and primary lung cancer (PLC). Moreover, healthy people who underwent physical examination were enrolled as the healthy population group (HPG) during the same period. On the one hand, to study lung metastases screening in healthy people, PMC was compared with HPG. The multivariate statistical analysis method was used to find the significant low-molecular metabolites between the two groups, and their discriminating ability was verified by the ROC curve. On the other hand, from the perspective of differential diagnosis of lung metastases, three groups with different pulmonary lesions (PMC, BPN, and PLC) were compared as a whole, and then the other two groups were compared with PMC, respectively. The main low-molecular metabolites were selected, and their discriminating ability was verified. Results In terms of lung metastases screening for healthy people, four significant low-molecular metabolites were found by comparison of PMC and HPG. They were O-arachidonoyl ethanolamine, adrenoyl ethanolamide, tricin 7-diglucuronoside, and p-coumaroyl vitisin A. In terms of the differential diagnosis of pulmonary nodules, the significant low-molecular metabolites selected by the comparison of the three groups as a whole were anabasine, octanoylcarnitine, 2-methoxyestrone, retinol, decanoylcarnitine, calcitroic acid, glycogen, and austalide L. For the comparison of PMC and BPN, L-tyrosine, indoleacrylic acid, and lysoPC (16 : 0) were selected, while L-octanoylcarnitine, retinol, and decanoylcarnitine were selected for the comparison of PMC and PLC. Their AUCs of ROC are all greater than 0.80. It indicates that these substances have a strong ability to differentiate between pulmonary metastatic carcinoma and other pulmonary nodule lesions. Conclusion Through the research of plasm metabolomics, it is possible to effectively detect the changes in some low-molecular metabolites among primary lung cancer, pulmonary metastatic carcinoma, and benign pulmonary nodule patients and healthy people. These significant metabolites have the potential to be biomarkers for screening and differential diagnosis of lung metastases.

Capecitabine in pretreated metastatic pulmonary lymphoepithelioma-like carcinoma: A retrospective study.

9093 Background: Pulmonary lymphoepithelioma-like carcinoma (LELC) is a rare disease, sharing common histological features with the undifferentiated subtype of nasopharyngeal carcinoma (NPC), and being under-represented in non-small cell lung cancer trials and clinical guidelines. While gemcitabine-based platinum doublet chemotherapy is more established in 1st line treatment of stage IV disease, there is limited evidence for subsequent treatment strategy. Oral capecitabine is one of the active agents in metastatic NPC, and was observed to have encouraging outcomes in pulmonary LELC. Methods: All consecutive patients with pulmonary LELC in 2010 – 2019 treated in a tertiary institution were reviewed. Patients with metastatic disease who progressed after gemcitabine-based platinum doublets and treated with capecitabine were included. Capecitabine was given at 1250 mg/m2 twice daily for 14 days followed by 7 days of rest in each cycle. Treatment response was monitored by clinical history, physical examination and imaging. Treatment was continued till drug holiday, intolerance or disease progression. Progression-free survival (PFS) and overall survival (OS) were estimated by the Kaplan-Meier method. Clinical predictors for PFS and OS were analyzed using log-rank test and the Cox proportional hazard model. Results: Of the 140 LELC patients identified, 36 patients satisfied the above inclusion criteria (14 male, 22 female). Median age was 58.6 years old (range 41.5 – 75.6). All patients had an ECOG performance score of 0 or 1. 16 patients (44.4%) received 2 or more lines of prior systemic treatment. Median capecitabine cycles received was 5 (range 2 – 68). Objective response rate was 27.8% (complete response: 5.6%; partial response: 22.2%), disease control rate was 75.0%. With a median follow-up of 15.3 months (range 1.8 – 82.6), the median PFS and OS were 5.4 months (95% CI, 2.1 – 8.8) and 15.4 months (95% CI, 10.0 – 20.7) respectively. Capecitabine was generally well tolerated, with 22.2% grade 3 or above side effects, and 5.6% treatment termination due to intolerance. Bone and distant lymph node (LN) involvement were significant predictors of poorer PFS on multivariate analyses (bone: HR 3.24, 95% CI 1.44 – 7.29, p=0.004; distant LN: HR: 2.62, 95% CI 1.14 – 6.02, p=0.024). Age, sex, smoking history, number of treatment lines, and other sites of disease involvement were not significant predictors. Conclusions: This is to date the largest reported cohort of capecitabine in pre-treated metastatic pulmonary LELC. Capecitabine is effective and well tolerated, and should be considered as a treatment option after 1st line platinum-based chemotherapy. Future studies are warranted to delineate the optimal treatment pathway of this rare disease entity.

Immune checkpoint inhibitors plus chemotherapy in patients with locally advanced or metastatic pulmonary sarcomatoid carcinoma: a multicentric real-world study.

Immune checkpoint inhibitors (ICIs) have demonstrated promising efficacy as monotherapy in patients with pulmonary sarcomatoid carcinoma (PSC). We performed the current multi-institutional, real-world study to assess the efficacy of ICIs plus chemotherapy in patients with PSC. All consecutive patients with locally advanced or metastatic PSC from three centers treated with ICIs between January 2018 and July 2021 were enrolled. Programmed death ligand 1 (PD-L1) expression was stained and evaluated using immunohistochemical with 22C3. Single-cell RNA sequencing (scRNA-seq) was performed in two patients with PSC and two patients with adenocarcinoma to understand the cell-type-specific transcriptome landscape of cancer cells and tumor microenvironment (TME) of PSC. A cohort of 42 PSC patients was identified. In the overall population, the objective response rate (ORR) was 73.8%, median progression-free survival (mPFS) was 10.3 months and median overall survival was not reached and 2-year survival rate was 51.2%. For 34 treatment-naïve patients who received first-line ICIs plus chemotherapy, the ORR was 70.6%, mPFS was 10.3 months and 2-year survival rate was 57.8%. In patients with PD-L1 tumor proportion score (TPS) < 1%, 1-49%, and ⩾50%, the ORR was 33.3%, 72.7%, and 85.7% and mPFS was 6.0, 6.7, and 10.3 months, respectively. Notably, two patients with transformed PSC from lung adenocarcinoma after epidermal growth factor receptor-tyrosine kinase inhibitor treatment also responded well to ICIs plus chemotherapy. scRNA-seq revealed immune-cell-inflamed TME, lower intratumoral heterogeneity, and activated immune response pathway in PSC. Our study demonstrated remarkable efficacy of ICIs plus chemotherapy as first-line therapy for patient with locally advanced or metastatic PSC.

Tolerability and outcome of palliative treatment for metastatic pulmonary carcinoma in cats.

Pulmonary carcinoma is uncommon in cats and reporting of outcomes following medical treatment is limited, especially in presence of metastases. The aim of this study was to describe the outcome of cats affected by metastatic primary pulmonary carcinoma and to evaluate the tolerability of palliative treatment in this patient population. Medical records were searched for cats with a cytological or histopathological diagnosis of primary pulmonary carcinoma and evidence of metastatic disease. Cats were treated with antineoplastic agents, corticosteroids, non-steroidal anti-inflammatory drugs (NSAIDs) or received no systemic treatment. Cases in which thoracic CT was not performed, and those lacking definitive diagnosis by cytology or histopathology or receiving curative-intent surgery were excluded. Thirty-four cats were identified: 18 were treated with antineoplastic agents and 16 received corticosteroids, NSAIDs or no treatment. Presenting clinical signs included coughing (53%), tachypnoea (26%), gastrointestinal signs (35%) and lethargy (18%). CT scan identified metastases to the lung parenchyma in all cases and additional metastatic lesions in 10 of 34 (59%) cases; pleural effusion was detected in 11 cases (32%). The overall median survival time for all cats was 64 days [range 1-1352 days; 95% confidence interval (CI) 48-164]. Presence of respiratory signs at presentation was the only factor influencing survival in the multivariable analysis. Medical treatment was well tolerated and appeared to palliate clinical signs in cats with metastatic pulmonary carcinoma, albeit with a modest duration and short overall survival. The role and benefit of chemotherapy/antineoplastic agents versus conventional palliative drugs in this setting remains unclear.

Clinicopathological features and prognostic analysis of metastatic pulmonary sarcomatoid carcinoma: a SEER analysis.

BackgroundPulmonary sarcomatoid carcinoma (PSC) is a rare type of non-small cell lung cancer (NSCLC). Metastases are often detected at the first diagnosis. Despite high rates of distant metastasis, there is insufficient data describing the characteristics of PSC metastasis.MethodsWe performed a Surveillance, Epidemiology, and End Results (SEER) database-based analysis of clinicopathological features and prognosis of distant metastasis in PSC patients. Data queried for this analysis included PSC patients in the database between 2010 and 2016.ResultsA total of 934 patients met the criteria for inclusion in the analysis and included, at the time of diagnosis, 512 (54.8%) patients with metastasis, including bone (n=152; 16.3%), brain (n=108; 11.6%), liver (n=70; 7.5%), lung (n=142; 15.2%) metastases. Binary logistic regression showed that patients with giant cell carcinoma [odds ratio (OR) 4.023, 95% confidence interval (CI): 2.113–7.661, P<0.001] and spindle cell carcinoma (OR 3.151, 95% CI: 1.699–5.843, P<0.001) were associated with metastasis. Log-rank test and Kaplan-Meier plots indicated poor prognosis in metastatic patients [the 1-, 3-, and 5-year overall survival (OS) rates were 14.1%, 5.5%, and 4.8%, respectively]. Multivariable analysis showed younger and chemotherapy as improved prognostic factors of PSC patients with single metastasis site.ConclusionsThe SEER database-based analysis revealed the clinical features of distant metastasis of PSC and showed that different histological types posed distinct metastasis potential. Besides, age and chemotherapy were the independent prognostic factors of PSC patients with single metastasis site.

Therapeutic Effect of CT-guided ¹²⁵I Seed Implantation on Advanced Lung Cancer and Pulmonary Metastatic Carcinoma

背景与目的原发性肺癌及肺转移癌均为常见肺部恶性肿瘤，是主要的癌症相关死亡原因。晚期肺癌及肺转移癌以全身治疗为主，局部治疗对全身治疗后肺部残存的顽固性病灶或复发病灶为一种有效治疗手段。125I放射性粒子植入作为一种高效的适形放疗，对肺部局限性癌灶具有一定的控制作用。本研究旨在探讨计算机断层扫描（computed tomography, CT）引导下经皮穿刺肺组织间125I放射性粒子植入治疗晚期肺癌和肺转移癌的临床效果及安全性。方法连续性收集2014年1月1日-2018年11月30日浙江大学医学院附属第一医院胸外科行125I放射性粒子植入术治疗的105例晚期肺癌和肺转移癌患者的临床病理资料，术后随访至2019年3月。观察粒子植入术的临床疗效及并发症发生情况。结果本研究共纳入105例患者，晚期肺癌患者78例，肺转移癌患者27例。粒子治疗患者术后中位生存时间为395天，术后1年生存率约为78.1%，术后2年生存率约为56.1%。粒子植入治疗晚期肺癌的效果与肺转移癌的效果相当。粒子联合射频消融、微波消融、化疗并没有提高粒子治疗效果。但是粒子联合外放射治疗较单纯粒子治疗具有显著生存劣势。结论CT引导下125I放射性粒子植入术并发症可控，可以作为晚期肺癌和肺转移癌的一种安全有效的治疗方法。

Metastatic HPV-Associated Oropharyngeal Versus Primary Pulmonary Squamous Cell Carcinoma: is p16 Immunostain Useful?

The lungs are a common site of metastasis of head and neck (H&N) squamous cell carcinomas (SCC). This study attempts to define p16 immunoexpression and presence of HPV in primary SCC of the lung and determine their usefulness in discriminating between primary lung SCC and metastasis from HPV-associated oropharyngeal primary. Pathology archives were searched for patients with SCC of the lung without SCC elsewhere. Tissue microarray was constructed and immunohistochemistry performed using anti-p40 and anti-p16 antibodies. All cases were tested for HPV viral proteins E6/E7 by RNA in situ hybridization (ISH) and available positive cases for HPV DNA by polymerase chain reaction (PCR). Eight of 25 (32%) showed cytoplasmic and nuclear expression of p16: 2 (8%) strong and 2 (8%) moderate in > 70% of tumor cells; 1 (4%) strong, 1 (4%) moderate, and 1 (4%) weak in 50-70% of tumor cells; 1 (4%) weak in < 50% of tumor cells. E6/E7 mRNA ISH was negative in all cases. Seven of 8 (87.5%) p16-expressing cases were available for testing by HPV PCR; all were negative for HPV DNA. A retrospective control group of 12 patients with possible SCC metastatic to lung was also identified; high-risk HPV DNA was present in 3, confirming metastasis. p16 expression in lung SCC is not uncommon and may not discriminate between primary pulmonary SCC and metastasis from HPV-associated oropharyngeal primary. Confirmatory HPV testing (high risk HPV DNA or E6/E7 mRNA) is recommended to differentiate metastasis from oropharyngeal primary from two separate primaries.

Metastatic pulmonary sarcomatoid carcinoma presenting in an infant

Abstract Pulmonary sarcomatoid carcinoma is a rare subtype of non-small cell lung cancer typically seen in elderly male patients, accounting for 0.1–0.4% of all lung cancers [1]. We present a case report of a 3-month old boy diagnosed with pulmonary sarcomatoid carcinoma after presenting to the emergency department with respiratory distress. This is the first reported case of pulmonary sarcomatoid carcinoma presenting in an infant.

First-line platinum-based chemotherapy and survival outcomes in locally advanced or metastatic pulmonary lymphoepithelioma-like carcinoma

ObjectivesPulmonary lymphoepithelioma-like carcinoma (LELC) is a rare subtype of primary lung cancer. Due to the lack of prospective studies, the optimal first-line chemotherapy regimens and survival outcomes remain unclear. Materials and methodsThis real-world, retrospective study enrolled consecutive patients with unresectable pulmonary LELC. The survival outcomes, prognosis, and comparative efficacy of different chemotherapy regimens were investigated. ResultsIn total, 127 patients were included in the analyses. The first-line chemotherapy regimens included gemcitabine plus platinum (GP, n = 19 [15.0%]), taxanes plus platinum (TP, n = 70 [55.1%]) and pemetrexed plus platinum (AP, n = 38 [30.0%]). 25 (19.7%) patients underwent palliative thoracic radiotherapy. 60 (47.2%) patients had detectable baseline Epstein-Barr virus (EBV) DNA. For the entire cohort, objective response was obtained in 41 patients (32.3%). Median progression-free survival (PFS) and overall survival (OS) were 7.7 months (95% CI, 6.6–8.8) and 36.7 months (95% CI, 30.9–42.5), respectively. Among the three chemotherapy regimens, GP achieved the highest response rate (GP, 63.2% vs. TP, 30.0% vs. AP, 21.1%; p = 0.005). Median PFS in the GP group (8.8 months) was also significantly longer than that in the TP group (7.9 months) and AP group (6.4 months) (p = 0.031). In the multivariate model, cycles of first-line chemotherapy (p < 0.001), palliative thoracic radiotherapy (p < 0.001), and chemotherapy regimens (p = 0.031) remained independent prognostic factors for PFS; while cycles of first-line chemotherapy (p = 0.002), baseline EBV DNA (p = 0.033) and palliative thoracic radiotherapy (p = 0.041) were significantly associated with OS. ConclusionGemcitabine-based chemotherapy and palliative thoracic radiotherapy are active in pulmonary LELC. These data provide added evidence for the similarity between pulmonary LELC and nasopharyngeal carcinoma in endemic area. Randomized controlled studies are needed to further define the standard-of-care for patients with advanced pulmonary LELC.

SAT-585 Presence of Metastatic Medullary Thyroid Cancer without a Distinct Thyroid Nodule: A Diagnostic Challenge

Introduction Neuroendocrine tumors originate from the GI tract, lungs or endocrine glands. Diagnosis can be done by different imaging modalities including Octreoscan, MIBG scan, FDG PET/CT and Ga-Dotatate PET/CT. Case 52 year old female with past history of hypertension, presented to an outside facility with complaint of a right lower neck mass, hoarseness and cough. Thyroid ultrasound identified a 0.3 cm right lobe calcific density with no discrete nodules. Neck CT showed right thyroid calcification and a 2.5 cm right supraclavicular mass. A core needle biopsy of the mass was consistent with metastatic low grade neuroendocrine carcinoma. Immunostains were positive for EP-CAM, TTF-1, synaptophysin, CD56 and CK7. Metastatic pulmonary carcinoma was suspected. She was seen at our institution for a multidisciplinary team evaluation. Pathology slides for additional stains were unavailable. Whole body CT showed low suspicion mediastinal lymph nodes. FDG PET/CT showed a 2.6 cm right neck hypermetabolic mass and a tiny calcified density in the right thyroid lobe, but no metastatic disease elsewhere. Endoscopic ultrasound-guided transbronchial biopsy of the mediastinal nodes was negative for cancer. An Octreotide scan showed only right neck mass hypermetabolism. Gallium-68 Dotatate scan had just become available and was able to identify increased uptake in the right supraclavicular region and an additional focus of uptake within the superior aspect of the right thyroid lobe. Fine-needle aspiration of the right thyroid focus was consistent with medullary thyroid carcinoma. Calcitonin was 1268 pg/ml, CEA 1.7 ng/ml and RET proto-oncogene was positive (p.C609Y). She had normal parathyroid hormone, calcium and plasma metanephrines. Total thyroidectomy was performed. Pathology was consistent with right neck metastatic medullary thyroid carcinoma with 18/27 lymph nodes involved. Multifocal medullary thyroid carcinoma from 0.2-0.6 cm was found in the right lobe. The left lobe had a 0.2 cm focus of medullary thyroid carcinoma with 1/2 lymph nodes involved. Her most recent neck ultrasound showed a persistent, stable hypoechoic 0.5 cm right lateral neck lesion. Most recent neck CT was unremarkable. PET/CT done 2 months ago showed only mildly prominent mediastinal lymph nodes that are stable compared with 2 years ago. Calcitonin decreased initially from 1268 pg/ml to 321 pg/ml and has now plateaued in the low 500s. CEA and other biomarkers are normal. Patient's daughter and son tested positive for the RET proto-oncogene mutation. Conclusion Metastatic medullary thyroid carcinoma without a discrete thyroid nodule is an uncommon presentation. Our patient presented with a metastatic neuroendocrine neck mass and conventional imaging modalities failed to identify the primary site, leading to delay in proper treatment. Ga-Dotatate PET/CT may improve management of patients with neuroendocrine tumors.

Survival analysis of dogs with advanced primary lung carcinoma treated by metronomic cyclophosphamide, piroxicam and thalidomide.

Unresectable or metastatic (advanced) primary pulmonary carcinoma (PPC) represents a therapeutic challenge where surgery may be contraindicated and the therapeutic role of maximum-tolerated dose (MTD) chemotherapy remains uncertain. This study was undertaken to explore the impact of metronomic chemotherapy (MC) in dogs with advanced PPC. Previously untreated dogs with advanced (T3 or N1 or M1) PPC, with complete staging work-up and follow-up data, receiving MC (comprising low-dose cyclophosphamide, piroxicam and thalidomide), surgery, MTD chemotherapy or no oncologic treatment were eligible for inclusion. For all patients, time to progression (TTP) and survival time (ST) were evaluated. Quality-of-life (QoL) was only evaluated in patients receiving MC. To assess QoL, owners of dogs receiving MC were asked to complete a questionnaire before and during treatment. Ninety-one dogs were included: 25 received MC, 36 were treated with surgery, 11 with MTD chemotherapy and 19 received no treatment. QoL was improved in dogs receiving MC. Median TTP was significantly longer in patients receiving MC (172 days) than patients undergoing surgery (87 days), receiving MTD chemotherapy (22 days), or no oncologic treatment (20 days). Median ST was similarly longer in patients receiving MC (139 days) than those undergoing surgery (92 days), MTD chemotherapy (61 days) and no oncologic treatment (60 days). In dogs with advanced PPC, MC achieved a measurable clinical benefit without significant risk or toxicity. This makes MC a potential alternative to other recognized management approaches.

A Comparative Review of Demographics, Incidence, and Epidemiology of Histologically Confirmed Intracranial Tumors in Brazil and Bulgaria.

Intracranial tumors (ICTs) attract numerous scientific teams and tremendous financial resources worldwide. These lesions of the central nervous system (CNS) can be both benign and malignant in biological behavior as well as local or metastatic in origin. We compared data from two studies on primary and metastatic ICTs from Brazil and Bulgaria, based on histopathologically confirmed ICTs from tertiary health centers. Primary ICTs significantly outweigh the frequency of metastatic ICTs. Primary ICTs represent 86.45% in Brazil and 69.17% in Bulgaria, with around 60% of their totals being malignant. There is a statistical dominance of tumors from the neuroepithelial origin, with the most common entry being glioblastoma multiforme. The second-most common primary ICT group comprises tumors of meningeal origin. Metastatic ICTs show great variance; 13.55% in Brazil and 31.38% in Bulgaria of all ICT cases being attributed to them. However, metastatic ICTs are even a more diverse group than neuroepithelial tumors, with the majority of this group comprising metastatic colorectal adenocarcinoma (almost exclusively in males), metastatic breast adenocarcinoma in females, metastatic pulmonary carcinomas (primarily from the non-small cell group with a male predominance), and metastatic melanoma with an even gender ratio.

Acute adrenal insufficiency as a first sign of metastatic pulmonary carcinoma

Acute adrenal insufficiency as a first sign of metastatic pulmonary carcinoma