BACKGROUND The accurate prediction of lymph node metastasis(LNM)is crucial for managing locally advanced(T3/T4)colorectal cancer(CRC).However,both traditional histopathology and standard slide-level deep learning ofte...BACKGROUND The accurate prediction of lymph node metastasis(LNM)is crucial for managing locally advanced(T3/T4)colorectal cancer(CRC).However,both traditional histopathology and standard slide-level deep learning often fail to capture the sparse and diagnostically critical features of metastatic potential.AIM To develop and validate a case-level multiple-instance learning(MIL)framework mimicking a pathologist's comprehensive review and improve T3/T4 CRC LNM prediction.METHODS The whole-slide images of 130 patients with T3/T4 CRC were retrospectively collected.A case-level MIL framework utilising the CONCH v1.5 and UNI2-h deep learning models was trained on features from all haematoxylin and eosinstained primary tumour slides for each patient.These pathological features were subsequently integrated with clinical data,and model performance was evaluated using the area under the curve(AUC).RESULTS The case-level framework demonstrated superior LNM prediction over slide-level training,with the CONCH v1.5 model achieving a mean AUC(±SD)of 0.899±0.033 vs 0.814±0.083,respectively.Integrating pathology features with clinical data further enhanced performance,yielding a top model with a mean AUC of 0.904±0.047,in sharp contrast to a clinical-only model(mean AUC 0.584±0.084).Crucially,a pathologist’s review confirmed that the model-identified high-attention regions correspond to known high-risk histopathological features.CONCLUSION A case-level MIL framework provides a superior approach for predicting LNM in advanced CRC.This method shows promise for risk stratification and therapy decisions,requiring further validation.展开更多
BACKGROUND The incidence of malignant gastrointestinal(GI)tumors is increasing,and advancements in medical care have significantly improved patient survival rates.As a result,the number of cases involving multiple pri...BACKGROUND The incidence of malignant gastrointestinal(GI)tumors is increasing,and advancements in medical care have significantly improved patient survival rates.As a result,the number of cases involving multiple primary cancers(MPC)has also increased.The rarity of MPC and the absence of sensitive and specific dia-gnostic markers often lead to missed or incorrect diagnoses.It is,therefore,of vital importance to improve the vigilance of clinicians and the accurate diagnosis of this disease.Patients with GI malignancies face a higher relative risk of deve-loping additional primary malignant tumors compared to those with other systemic tumors.Vigilant monitoring and follow-up are crucial,especially for high-risk groups,which include older adults,men,those with addictions to alcohol and tobacco,those with a family history of tumors,and those who have undergone radiotherapy.CASE SUMMARY In this article,we report three cases of MPC,each involving malignant tumors of the GI tract as the initial primary carcinoma,offering insights that may aid in effectively managing similar cases.CONCLUSION Patients with GI malignancies face a higher MPC risk.Developing screening and follow-up protocols may enhance detection and treatment outcomes.展开更多
High microsatellite instability(MSI-H)colorectal cancer(CRC),caused by deficient mismatch repair,accounts for about 15%of all CRC cases and is more common in right-sided tumors.While early-stage MSI-H CRC has a relati...High microsatellite instability(MSI-H)colorectal cancer(CRC),caused by deficient mismatch repair,accounts for about 15%of all CRC cases and is more common in right-sided tumors.While early-stage MSI-H CRC has a relatively good prognosis,advanced cases often respond poorly to standard chemotherapy.Immune checkpoint inhibitors,such as pembrolizumab,have shown strong and lasting effects in MSI-H CRC.Pembrolizumab is now approved as a first-line treatment for metastatic MSI-H CRC due to its superior outcomes compared to traditional chemotherapy.CASE SUMMARY A 44-year-old male with MSI-H transverse colon cancer presented with hematochezia,abdominal pain,and significant weight loss.Imaging revealed a bulky tumor with invasion of adjacent structures and multiple liver lesions.A diverting ileostomy was performed followed by 36 cycles of pembrolizumab.The patient achieved a clinical and radiologic complete response.One month after completing the treatment,the patient underwent laparoscopic right hemicolectomy.A spontaneous transection of the colon at the original tumor site was unexpectedly identified.Final pathology confirmed pathological complete response(ypT0N0)with fibrosis.The patient recovered well after surgery,and follow-up showed no evidence of recurrence.CONCLUSION Immune checkpoint inhibitors may cause delayed structural damage to bowel tissue even after apparent complete tumor regression.展开更多
BACKGROUND Gallbladder cancer(GBC)is the most common and aggressive subtype of biliary tract cancer(BTC)and has a poor prognosis.A newly developed regimen of gemcitabine,cisplatin,and durvalumab shows promise for the ...BACKGROUND Gallbladder cancer(GBC)is the most common and aggressive subtype of biliary tract cancer(BTC)and has a poor prognosis.A newly developed regimen of gemcitabine,cisplatin,and durvalumab shows promise for the treatment of advanced BTC.However,the efficacy of this treatment for GBC remains unclear.CASE SUMMARY In this report,we present a case in which the triple-drug regimen exhibited marked effectiveness in treating locally advanced GBC,thus leading to a long-term survival benefit.A 68-year-old man was diagnosed with locally advanced GBC,which rendered him ineligible for curative surgery.Following three cycles of therapy,a partial response was observed.After one year of combined therapy,a clinical complete response was successfully achieved.Subsequent maintenance therapy with durvalumab monotherapy resulted in a disease-free survival of 9 months for the patient.The patient experienced tolerable toxicities of reversible grade 2 nausea and fatigue.Tolerable adverse events were observed in the patient throughout the entirety of the treatment.CONCLUSION The combination of gemcitabine and cisplatin chemotherapy with durvalumab was proven to be an effective treatment approach for advanced GBC,with manageable adverse events.Further research is warranted to substantiate the effectiveness of the combined regimen in the context of GBC.展开更多
BACKGROUND Small cell lung cancer(SCLC)is the most malignant type of lung cancer.Even in the latent period and early stage of the tumor,SCLC is prone to produce distant metastases with complex and diverse clinical man...BACKGROUND Small cell lung cancer(SCLC)is the most malignant type of lung cancer.Even in the latent period and early stage of the tumor,SCLC is prone to produce distant metastases with complex and diverse clinical manifestations.SCLC is most closely related to paraneoplastic syndrome,and some cases present as paraneoplastic peripheral neuropathy(PPN).PPN in SCLC appears early,lacks specificity,and often occurs before diagnosis of the primary tumor.It is easy to be misdiagnosed as a primary disease of the nervous system,leading to missed diagnosis and delayed diagnosis and treatment.CASE SUMMARY This paper reports two cases of SCLC with limb weakness as the first symptom.The first symptoms of one patient were rash,limb weakness,and abnormal electromyography.The patient was repeatedly referred to the hospital for limb weakness and rash for>1 year,during which time,treatment with hormones and immunosuppressants did not lead to significant improvement,and the condition gradually aggravated.The patient was later diagnosed with SCLC,and the dyskinesia did not worsen as the dermatomyositis improved after antineoplastic and hormone therapy.The second case presented with limb numbness and weakness as the first symptom,but the patient did not pay attention to it.Later,the patient was diagnosed with SCLC after facial edema caused by tumor thrombus invading the vein.However,he was diagnosed with extensive SCLC and died 1 year after diagnosis.CONCLUSION The two cases had PPN and abnormal electromyography,highlighting its correlation with early clinical indicators of SCLC.展开更多
BACKGROUND Colorectal cancer(CRC)ranks high among the most common types of malignant tumors.The primary cause of cancer-related mortality is metastasis,with lung metastases accounting for 32.9%of all cases of metastat...BACKGROUND Colorectal cancer(CRC)ranks high among the most common types of malignant tumors.The primary cause of cancer-related mortality is metastasis,with lung metastases accounting for 32.9%of all cases of metastatic CRC(MCRC).However,cases of MCRC in the lungs,which present concurrently with primary peripheral lung adenocarcinoma,are exceptionally rare.CASE SUMMARY This report describes the case of a 52-year-old female patient who,following a colonoscopy,was diagnosed with moderately differentiated adenocarcinoma based on rectal mucosal biopsy findings.A preoperative chest computed tomography scan revealed a ground-glass nodule in the right lung and a small nodule(approximately 0.6 cm in diameter)in the extramural basal segment of the left lower lobe,which suggested multiple lung metastases from rectal cancer.Subsequent treatment and follow-up led to a diagnosis of rectal cancer with left lung metastasis and peripheral adenocarcinoma of the lower lobe of the right lung.CONCLUSION This case report describes the therapeutic journey of a patient with lung metastasis from rectal cancer in addition to primary peripheral adenocarcinoma,thus underscoring the critical roles of multidisciplinary collaboration,personalized treatment strategies,and comprehensive patient rehabilitation guidance.展开更多
BACKGROUND Cervical cancer is a formidable global health issue,particularly affecting women in lower-middle-income countries with little or no access to preventative vaccines,screening programs,and treatment modalitie...BACKGROUND Cervical cancer is a formidable global health issue,particularly affecting women in lower-middle-income countries with little or no access to preventative vaccines,screening programs,and treatment modalities.The case report presents a unique case of a large cervical cancer achieving complete response(CR)with concurrent chemoradiotherapy(CCRT),highlighting the effectiveness of this treatment approach even in advanced stages and underscoring the importance of adaptive radiotherapy(RT)in optimizing patient outcomes.CASE SUMMARY We present the case of a 53-year-old woman who presented with four years of abnormal vaginal bleeding and was found to have p16-positive,moderately differentiated cervical squamous cell carcinoma.The tumor measured 14 cm×12 cm×8 cm,the largest size reported in the literature to achieve CR with CCRT.Despite this monumental feat,the patient remained disease-free and is currently on follow-up for 2 years;however,she continued to suffer from substantial morbidity caused by a vesicovaginal fistula and hydronephrosis,underscoring the continuing impact of cervical cancer on quality of life.CONCLUSION In this case report,we highlight the effectiveness of CCRT in achieving CR,even in cases of bulky cervical cancer,with adaptive RT offering a customized strategy to improve patient outcomes.We also emphasize the necessity for multidisciplinary team discussions and highlight the need for strategies to mitigate treatment-related toxicities and long-term complications.展开更多
BACKGROUND The programmed cell death protein 1 inhibitor pembrolizumab has become a key treatment for various cancers,including triple-negative breast cancer.However,it is associated with immune-related adverse events...BACKGROUND The programmed cell death protein 1 inhibitor pembrolizumab has become a key treatment for various cancers,including triple-negative breast cancer.However,it is associated with immune-related adverse events,including rare but serious neurological complications such as Guillain-Barrésyndrome(GBS).GBS is a potentially life-threatening autoimmune disorder characterized by muscle weakness and paralysis.We present a unique case of pembrolizumab-induced GBS to highlight the importance of recognizing this complication and managing it promptly in patients receiving immune checkpoint inhibitors.CASE SUMMARY A 69-year-old woman with a medical history of hypertension,anxiety,depression,and stage IIIB triple-negative breast cancer treated with pembrolizumab,carboplatin,and paclitaxel,presented to the emergency department with a 1-month history of tingling,lower extremity weakness,and shooting pain.Symptoms progressed to global weakness,ascending paralysis,and double vision.Neurological examination revealed significant lower extremity weakness and sensory deficits.Magnetic resonance imaging of the lumbar spine and cerebrospinal fluid analysis confirmed GBS.Initial treatment with intravenous immunoglobulin led to relapse,requiring additional intravenous immunoglobulin and high-dose glucocorticoids.The patient’s condition improved,pembrolizumab therapy was permanently discontinued,and she was discharged to a rehabilitation facility.CONCLUSION Pembrolizumab can induce GBS,necessitating early recognition,prompt diagnosis,and multidisciplinary management to prevent serious complications.展开更多
BACKGROUND Multiple primary malignant tumors refer to the occurrence of two or more primary malignant tumors in the same organ or multiple organs or tissues at the same time or successively in the same patient,and can...BACKGROUND Multiple primary malignant tumors refer to the occurrence of two or more primary malignant tumors in the same organ or multiple organs or tissues at the same time or successively in the same patient,and can occur anywhere in the body.The treatment guidelines for patients with multiple primary malignant tumors are currently controversial.CASE SUMMARY A 51-year-old male patient with liver cancer and portal hypertension received 42 months of co-treatment with atezolizumab and bevacizumab.After that,the disease was rated stable disease.The patient was then diagnosed with gastric cancer.Since the patient was not sensitive to anti-programmed death ligand 1 immunosuppressive agents,a co-treatment with oxaliplatin,tegafur,apatinib,and cadonilimab was selected after multidisciplinary consultation and the patient’s agreement.After four cycles of treatment,partial response and stable disease were observed in gastric and liver cancers,respectively.Surgical treatment was performed considering the high-risk factors of gastrointestinal bleeding in patients with gastroesophageal varices.Postoperative pathology showed that the Tumor Regression Grade was 1.Moreover,the genetic testing of postoperative tumor specimens indicated negative programmed death ligand 1 and microsatellite stability.In addition,the latest follow-up indicated an 8 and 40-month progression-free survival in gastric and liver cancer patients,respectively.Currently,the patient is receiving postoperative immunotherapy with cadonilimab.CONCLUSION Cadonilimab not only treats microsatellite stability gastric cancer patients but can also be used for liver cancer treatment.展开更多
BACKGROUND Colorectal cancer remains as one of the most common cancers that are diagnosed and remains as a significant contributor to morbidity and mortality.Despite advances in techniques,improving access to diagnost...BACKGROUND Colorectal cancer remains as one of the most common cancers that are diagnosed and remains as a significant contributor to morbidity and mortality.Despite advances in techniques,improving access to diagnostic modalities and increasing awareness,it often presents at a later stage and can recur despite treatment.Recurrence can be variable and can occur years after treatment.Liver is the most common location for metastasis to occur followed by lungs.However,atypical sites of metastasis can occur although unusual and colorectal cancer can spread to the spleen,hilum of the liver,adrenals,bone,skeletal muscles,skin,prostate,brain,parotid gland,thyroid gland and even the cardiac muscle.It is crucial to recognize the metachronous nature of the metastasis and to only present at a single site as within this lies the rarity of the case.The mass itself mimicked a cholangiocarcinoma or a Klatskin’s tumor initially and only through pathology was the diagnosis established.We present an unusual case of recurrent colorectal cancer that occurred several years post treatment and presented as an isolated metastasis to the hilum of the liver leading to biliary obstruction without any other identifiable lesions including in the colon itself.CASE SUMMARY A 68-year-old male with history of colon cancer presented with obstructive jaundice to the hospital.After evaluation with imaging studies was diagnosed with mass at the hilum of the liver that was leading to obstruction.With percutaneous biopsies obtained by interventional radiology,the diagnosis of metastatic adenocarcinoma originating from the colon was established.He was deemed not to be a surgical candidate and is currently pursuing chemotherapy.CONCLUSION A metastatic adenocarcinoma of the colon that presents as a hilar mass and mimics cholangiocarcinoma is very rare.The metachronous nature along with the isolated metastasis involving the hilum of the liver makes this case unique.Diagnosis can be challenging and needs a tissue specimen along with immunostaining to achieve an accurate diagnosis and provide appropriate treatment.Biliary decompression is performed either endoscopically or percutaneously and is part of the multidisciplinary approach involving medical and surgical oncology teams.展开更多
BACKGROUND Esophageal squamous cell carcinoma(ESCC)is often managed with surgery,which is the first-line treatment option for stage I–III lesions.However,definitive chemoradiotherapy(dCRT)is associated with a recurre...BACKGROUND Esophageal squamous cell carcinoma(ESCC)is often managed with surgery,which is the first-line treatment option for stage I–III lesions.However,definitive chemoradiotherapy(dCRT)is associated with a recurrence rate of 30%in stage I ESCC and higher rates in advanced-staged lesions.However,several patients prefer dCRT because their general condition is poor.Salvage therapies,including esophagectomy and endoscopic resection[endoscopic submucosal dissection(ESD)/endoscopic mucosal resection],are important for residual or recurrent tumors that develop after dCRT.Esophagectomy can have curative potential.However,it has high complication and mortality rates.Therefore,ESD is a safer alternative.CASE SUMMARY A Japanese man in his 70s was concurrently diagnosed with right hypopha-ryngeal cancer(T2N1M0,cStage III),left oropharyngeal cancer(T1N0M0,cStage I),and left hard palate cancer(T1N0M0,cStage I).Esophagogastroduodenoscopy(EGD)revealed a 20 mm reddish 0-Is+IIb lesion in the upper thoracic esophagus,with an invasion depth of SM2.The lesion was diagnosed as an esophageal mo-derately differentiated squamous cell carcinoma(T1bN0M0,cStage I).As the pharyngeal cancers were in advanced stages,chemoradiotherapy(docetaxel and cisplatin with a radiation dose of 66 Gy)was prioritized.Post-chemoradiotherapy EGD showed that the lesion had flattened into a 0-IIb lesion,thereby indicating a reduced invasion depth(epi-thelium or lamina propria mucosa).ESD achieved en bloc and histologically confirmed curative resection.At 22 months after ESD,the patient did not present with signs of recurrence.CONCLUSION This case emphasizes that ESD can be successfully utilized as a salvage treatment for ESCC after chemoradio-therapy for otolaryngological cancers.展开更多
BACKGROUND Post-operative massive hemorrhage is a critical concern in oral cancer surgery,associated with severe complications and heightened morbidity and mortality rates.CASE SUMMARY A 46-year-old male with advanced...BACKGROUND Post-operative massive hemorrhage is a critical concern in oral cancer surgery,associated with severe complications and heightened morbidity and mortality rates.CASE SUMMARY A 46-year-old male with advanced poorly differentiated squamous cell carcinoma(ypT4aN3bN0M0)of the oral floor underwent extensive surgery,including total glossectomy,partial mandibulectomy,and free flap reconstruction.Postoperatively,he developed life-threatening hemorrhage on day 3 due to wound dehiscence.Rapid nursing interventions-prompt suture removal,pressure hemostasis,and multidisciplinary collaboration-controlled bleeding.Postoperative care emphasized hemodynamic monitoring,infection prevention,and rehabilitation.Despite comorbidities(hypertension,diabetes,prior stroke),the patient achieved functional recovery:Oral flap epithelialization,restored swallowing(water swallow test:Grade 1),70% tongue mobility,and 80% preoperative chewing efficiency at 6-month follow-up.This case underscores the critical role of structured nursing protocols in managing postoperative hemorrhage and optimizing outcomes in high-risk oral cancer surgery.CONCLUSION This case report highlights the pivotal role of structured nursing interventions in managing life-threatening postoperative hemorrhage following complex oral cancer surgery.By integrating meticulous preoperative risk stratification,intraoperative hemostatic collaboration,and vigilant postoperative monitoring(e.g.,timely suture management,pressure hemostasis,blood product administration),the interdisciplinary team achieved rapid hemorrhage control.Comprehensive psychological care and rehabilitation protocols further facilitated functional recovery,enabling the patient to regain swallowing,speech,and mobility despite advanced disease and comorbidities.The findings underscore that standardized nursing workflows,balancing procedural rigor with holistic patient support,are essential for mitigating complications and enhancing outcomes in high-risk head and neck surgical populations.展开更多
BACKGROUND Breast cancer(BC)metastasis to the gastrointestinal tract is uncommon,colonic metastasis from BC(CMBC)is even rarer.CASE SUMMARY This report describes a 44-year-old female patient with metastatic triple-neg...BACKGROUND Breast cancer(BC)metastasis to the gastrointestinal tract is uncommon,colonic metastasis from BC(CMBC)is even rarer.CASE SUMMARY This report describes a 44-year-old female patient with metastatic triple-negative BC in the ascending colon who underwent laparoscopic radical right hemicolectomy.The patient had undergone left modified radical mastectomy only 15 months ago and stopped chemotherapy just 3 months ago.The diagnosis of CMBC was made based on the previous history of BC and positive results of several specific immunohistochemical markers(gross cystic disease fluid protein 15,mammaglobin,GATA-binding protein 3,and cytokeratin 7)for breast carcinoma.CONCLUSION CMBC should be highly cautious in patients with a previous history of BC,especially triple-negative BC,and further examination to aid in diagnosis.展开更多
BACKGROUND This article discusses a case involving a 63-year-old man with non-small cell lung cancer,who was treated with a combination of chemotherapy and immunothe-rapy.The patient was treated with five cycles of ch...BACKGROUND This article discusses a case involving a 63-year-old man with non-small cell lung cancer,who was treated with a combination of chemotherapy and immunothe-rapy.The patient was treated with five cycles of chemotherapy(pemetrexed and carboplatin)combined with sintilimab,a programmed death 1 inhibitor.CASE SUMMARY After the fifth cycle of treatment,the patient developed skin itching and a vitiligo-like rash,which are known side effects of immunotherapy.Despite dermatologi-cal consultation and treatment with topical corticosteroids,the rash worsened while the itching subsided.The patient continued with the treatment,and after 15 cycles,the tumor showed a response with a reduction in size.The vitiligo-like rash increased,but the antitumor treatment remained effective.CONCLUSION The case highlights the use of immunotherapy in patients with non-small cell lung cancer and the potential side effect of vitiligo-like rash.The patient’s tumor res-ponded well to the treatment,and despite the skin reaction,the treatment was not discontinued due to its effectiveness.The article suggests that further studies are needed to understand the mechanism behind vitiligo in patients with lung cancer receiving immune checkpoint inhibitors and whether the development of vitiligo-like rash after immune checkpoint inhibitor therapy is associated with improved prognosis.The case also underscores the importance of managing immune-related adverse events in the context of effective antitumor treatment.展开更多
BACKGROUND Acute pancreatitis(AP)is commonly encountered in gastroenterology,with biliary and alcohol-related causes being predominant.Among less frequent etiologies,metabolic and drug-induced origin are the most prev...BACKGROUND Acute pancreatitis(AP)is commonly encountered in gastroenterology,with biliary and alcohol-related causes being predominant.Among less frequent etiologies,metabolic and drug-induced origin are the most prevalent.As an exception,non-pancreatobiliary malignancies may trigger AP,representing less than 1%of cases.We present a case of AP secondary to an uncommon oncologic etiology.CASE SUMMARY We describe the case of a 50-year-old male recently diagnosed with small-cell lung cancer(SCLC).The patient was admitted to the emergency department with acute abdominal pain and subsequently diagnosed with AP.He was hospitalized under the care of the gastroenterology service.During the etiological workup,metastatic pancreatic lesions were identified on imaging,which had not been observed on the initial cancer staging.Following resolution of the initial episode,oral intake was introduced,but the patient experienced recurrent abdominal pain and laboratory abnormalities consistent with new episodes of AP.This pattern repeated over the following days.After several episodes,and with suspicion of a metastatic origin,the case was discussed in multidisciplinary meeting.In agreement with the patient and given the need to initiate treatment for the primary tumor as well,chemotherapy was started.This treatment successfully alleviated symptoms,allowing dietary progression without complications and discharge from the hospital.CONCLUSION Oncologic treatment can be considered as part of the therapeutic approach in AP secondary to SCLC metastasis,especially chemotherapy.展开更多
BACKGROUND According to the literature,significant disorders of gut microbiota are consistently observed in patients with colorectal cancer(CRC).Disorders of gut microbiota composition are manifesting clinically as ab...BACKGROUND According to the literature,significant disorders of gut microbiota are consistently observed in patients with colorectal cancer(CRC).Disorders of gut microbiota composition are manifesting clinically as abdominal pain,dyspeptic symptoms(such as rumbling,bloating,and altered bowel habits,including both constipation and diarrhea),and overall reduced quality of life.Also,negative changes in the microbiota may be associated with a more frequent development of postoperative complications and complications during chemotherapy.CASE SUMMARY Two patients with CRC underwent surgery(laparoscopic left hemicolectomy)and were prescribed chemotherapy regimen consisted of cisplatin,leucovorin,and fluorouracil.Along with prescribed chemotherapy patients took autoprobiotic enterococci.A fecal sample was collected for autoprobiotic preparation,ensuring that the patient had not taken antibiotics,probiotic supplements,or probiotic-containing foods for at least 10 days.An autoprobiotic contained an indigenous strain of Enterococcus faecium(E.faecium)was formulated.The patients received the autoprobiotic strain E.faecium(liquid form with a concentration of 8 Lg CFU/mL)orally at a dose of 50 mL twice daily during 10 days,regardless of meal times,from the first day of cytostatic treatment,throughout the first course of chemotherapy.As a result,autoprobiotic intake improved patient well-being and prevent side effects associated with the use of cytostatics.CONCLUSION The use of autoprobiotics in the treatment of CRC is a promising area to reduce the risks of postoperative complications,increase the tolerability of the basic chemotherapeutic regimen,as well as improve the quality of life.展开更多
BACKGROUND The 5-year survival rate for patients with pancreatic cancer(PC)is 4%-12%.Surgery is the only treatment that offers curative potential,but only 15%-20%of patients are eligible for surgery.PC is prone to rec...BACKGROUND The 5-year survival rate for patients with pancreatic cancer(PC)is 4%-12%.Surgery is the only treatment that offers curative potential,but only 15%-20%of patients are eligible for surgery.PC is prone to recurrence and metastasis,and the antitumor effect of chemotherapy is notably limited.CASE SUMMARY Histopathological analysis of a 53-year-old female PC patient who underwent Whipple surgery revealed poorly differentiated tumor cells infiltrating nerves,lymphatics,and blood vessels.The patient received two different first-line chemotherapy regimens consecutively;however,both regimens struggled to control disease progression.During this period,the patient underwent liver metastasis ablation surgery,Candida albicans liver abscess,and stereotactic body radiotherapy.With the addition of camrelizumab to the modified FOLFIRINOX regimen,tumor control was achieved.The patient subsequently refused to continue chemotherapy,and the antitumor regimen was changed to a combination of camrelizumab and apatinib.After patients received a combination of immunotherapy and targeted therapy,the length of hospital stay was significantly reduced.Furthermore,all side effects were within acceptable limits,leading to an improved quality of life and prolonged progression-free survival.Unfortunately,the pain associated with cancer,coupled with the side effects of opioid analgesics,has led the patient to reject all available anticancer treatment options.Approximately one month after camrelizumab and apatinib were discontinued without medical authorization,the PC recurred and rapidly progressed to widespread metastasis,ultimately leading to the patient's death approximately one month later.The overall survival was 2 years.CONCLUSION Immunotherapy and targeted therapy have the potential to increase both the quality of life and survival time of PC patients,particularly those whose tumor progression is not effectively controlled by chemotherapy alone.Nevertheless,further clinical trials are necessary to validate these findings.展开更多
BACKGROUND Colon cancer is a common malignancy of the digestive tract.An estimated 1148515 new cases of colon cancer were reported in 2020 worldwide.Chronic myeloid leukemia(CML)is a malignant tumor formed by the clon...BACKGROUND Colon cancer is a common malignancy of the digestive tract.An estimated 1148515 new cases of colon cancer were reported in 2020 worldwide.Chronic myeloid leukemia(CML)is a malignant tumor formed by the clonal proliferation of bone marrow hematopoietic stem cells,with an annual incidence rate of 1-2 cases per 100000 people worldwide.Leukemia can be secondary to solid tumors,and vice versa.Reports on CML secondary malignant tumors account for 8.7% but CML secondary to malignancy is extremely rare.Therapy-related CML is a rare but potentially fatal adverse event of chemotherapy or radiotherapy.Herein,we report a case of CML with colon cancer and discuss this unique patient popu-lation.Our findings can provide effective raw data and guidance for the diagnosis of this clinical disease.CML in patients with colon cancer is extremely rare.Secondary hematological tumors may be multifactorial,and the exact mechanism is currently unknown.Owing to the slow progression of the disease,patients with CML show no sy-mptoms in the early stage.However,with disease progression,obvious but non-specific symptoms may appear,including fever,anemia,bleeding tendency,and hypertrophy.Therefore,complete blood count monitoring for routine examination is recommended after cancer treatment for early detection of occult hematological tumors.展开更多
BACKGROUND Treatment of metastatic gastric cancer(mGC)relies primarily on chemotherapy,which can be effectively combined with immunotherapy.Despite these interventions,overall survival remains suboptimal.CASE SUMMARY ...BACKGROUND Treatment of metastatic gastric cancer(mGC)relies primarily on chemotherapy,which can be effectively combined with immunotherapy.Despite these interventions,overall survival remains suboptimal.CASE SUMMARY We report a patient with mGC who received S-1 plus oxaliplatin with sintilimab as first-line therapy,followed by maintenance therapy with S-1 and sintilimab.After 6 months,a partial response was observed,with a 71.7%reduction in the target lesion.After 13 months,the reduction reached 76.3%.Treatment was temporarily paused for 6 months due to a pulmonary infection.Upon re-evaluation 6 months later,the tumor continued to regress,with a 79.4%reduction in the target lesion.The original regimen was then resumed.From diagnosis to date,progression-free survival has reached 23 months.CONCLUSION Sintilimab combined with chemotherapy demonstrated improved progressionfree survival and warrants further investigation in mGC.展开更多
BACKGROUND Gastric cancer is the fifth most common cancer and the fourth leading cause of death worldwide.Most cases of newly diagnosed gastric cancer involve not only locally advanced tumor growth and regional lymph ...BACKGROUND Gastric cancer is the fifth most common cancer and the fourth leading cause of death worldwide.Most cases of newly diagnosed gastric cancer involve not only locally advanced tumor growth and regional lymph node metastases but also distant metastases.We report a rare case finding of a mass in the right inguinal area which is derived from gastric cancer.CASE SUMMARY A 68-year-old male initially diagnosed with an inguinal hernia presented with a 2 cm mass in the right inguinal area.Gastrointestinal symptoms led to the discovery of a stomach tumor.Biopsy confirmed gastrointestinal adenocarcinoma.The diagnosis was advanced gastric cancer with peritoneal dissemination,and the inguinal mass was due to direct infiltration.Due to gastrointestinal bleeding,the patient underwent palliative gastrectomy and lymph node dissection.Postoperatively,the patient received hyperthermic intraperitoneal chemotherapy and localized radiation therapy.CONCLUSION This case indicates that a systematic evaluation should be conducted during the initial consultation to explore the potential connection between unrecognized distant masses and the primary tumor.展开更多
基金Supported by Chongqing Medical Scientific Research Project(Joint Project of Chongqing Health Commission and Science and Technology Bureau),No.2023MSXM060.
文摘BACKGROUND The accurate prediction of lymph node metastasis(LNM)is crucial for managing locally advanced(T3/T4)colorectal cancer(CRC).However,both traditional histopathology and standard slide-level deep learning often fail to capture the sparse and diagnostically critical features of metastatic potential.AIM To develop and validate a case-level multiple-instance learning(MIL)framework mimicking a pathologist's comprehensive review and improve T3/T4 CRC LNM prediction.METHODS The whole-slide images of 130 patients with T3/T4 CRC were retrospectively collected.A case-level MIL framework utilising the CONCH v1.5 and UNI2-h deep learning models was trained on features from all haematoxylin and eosinstained primary tumour slides for each patient.These pathological features were subsequently integrated with clinical data,and model performance was evaluated using the area under the curve(AUC).RESULTS The case-level framework demonstrated superior LNM prediction over slide-level training,with the CONCH v1.5 model achieving a mean AUC(±SD)of 0.899±0.033 vs 0.814±0.083,respectively.Integrating pathology features with clinical data further enhanced performance,yielding a top model with a mean AUC of 0.904±0.047,in sharp contrast to a clinical-only model(mean AUC 0.584±0.084).Crucially,a pathologist’s review confirmed that the model-identified high-attention regions correspond to known high-risk histopathological features.CONCLUSION A case-level MIL framework provides a superior approach for predicting LNM in advanced CRC.This method shows promise for risk stratification and therapy decisions,requiring further validation.
基金Supported by Gansu Provincial Natural Science Foundation,No.21JR1RA010In-Hospital Research Fund of Gansu Provincial Hospital,No.23GSSYD-5.
文摘BACKGROUND The incidence of malignant gastrointestinal(GI)tumors is increasing,and advancements in medical care have significantly improved patient survival rates.As a result,the number of cases involving multiple primary cancers(MPC)has also increased.The rarity of MPC and the absence of sensitive and specific dia-gnostic markers often lead to missed or incorrect diagnoses.It is,therefore,of vital importance to improve the vigilance of clinicians and the accurate diagnosis of this disease.Patients with GI malignancies face a higher relative risk of deve-loping additional primary malignant tumors compared to those with other systemic tumors.Vigilant monitoring and follow-up are crucial,especially for high-risk groups,which include older adults,men,those with addictions to alcohol and tobacco,those with a family history of tumors,and those who have undergone radiotherapy.CASE SUMMARY In this article,we report three cases of MPC,each involving malignant tumors of the GI tract as the initial primary carcinoma,offering insights that may aid in effectively managing similar cases.CONCLUSION Patients with GI malignancies face a higher MPC risk.Developing screening and follow-up protocols may enhance detection and treatment outcomes.
文摘High microsatellite instability(MSI-H)colorectal cancer(CRC),caused by deficient mismatch repair,accounts for about 15%of all CRC cases and is more common in right-sided tumors.While early-stage MSI-H CRC has a relatively good prognosis,advanced cases often respond poorly to standard chemotherapy.Immune checkpoint inhibitors,such as pembrolizumab,have shown strong and lasting effects in MSI-H CRC.Pembrolizumab is now approved as a first-line treatment for metastatic MSI-H CRC due to its superior outcomes compared to traditional chemotherapy.CASE SUMMARY A 44-year-old male with MSI-H transverse colon cancer presented with hematochezia,abdominal pain,and significant weight loss.Imaging revealed a bulky tumor with invasion of adjacent structures and multiple liver lesions.A diverting ileostomy was performed followed by 36 cycles of pembrolizumab.The patient achieved a clinical and radiologic complete response.One month after completing the treatment,the patient underwent laparoscopic right hemicolectomy.A spontaneous transection of the colon at the original tumor site was unexpectedly identified.Final pathology confirmed pathological complete response(ypT0N0)with fibrosis.The patient recovered well after surgery,and follow-up showed no evidence of recurrence.CONCLUSION Immune checkpoint inhibitors may cause delayed structural damage to bowel tissue even after apparent complete tumor regression.
基金Supported by General Project of Natural Science Foundation of Chongqing,China,No.cstc2021jcyj-msxmX0604Chongqing Doctoral"Through Train"Research Program,China,No.CSTB2022BSXM-JCX0045.
文摘BACKGROUND Gallbladder cancer(GBC)is the most common and aggressive subtype of biliary tract cancer(BTC)and has a poor prognosis.A newly developed regimen of gemcitabine,cisplatin,and durvalumab shows promise for the treatment of advanced BTC.However,the efficacy of this treatment for GBC remains unclear.CASE SUMMARY In this report,we present a case in which the triple-drug regimen exhibited marked effectiveness in treating locally advanced GBC,thus leading to a long-term survival benefit.A 68-year-old man was diagnosed with locally advanced GBC,which rendered him ineligible for curative surgery.Following three cycles of therapy,a partial response was observed.After one year of combined therapy,a clinical complete response was successfully achieved.Subsequent maintenance therapy with durvalumab monotherapy resulted in a disease-free survival of 9 months for the patient.The patient experienced tolerable toxicities of reversible grade 2 nausea and fatigue.Tolerable adverse events were observed in the patient throughout the entirety of the treatment.CONCLUSION The combination of gemcitabine and cisplatin chemotherapy with durvalumab was proven to be an effective treatment approach for advanced GBC,with manageable adverse events.Further research is warranted to substantiate the effectiveness of the combined regimen in the context of GBC.
基金Supported by Science and Technology Plan Project of Jiaxing,No.2021AD30044Supporting Discipline of Neurology in Jiaxing,No.2023-ZC-006Affiliated Hospital of Jiaxing University,No.2020-QMX-16.
文摘BACKGROUND Small cell lung cancer(SCLC)is the most malignant type of lung cancer.Even in the latent period and early stage of the tumor,SCLC is prone to produce distant metastases with complex and diverse clinical manifestations.SCLC is most closely related to paraneoplastic syndrome,and some cases present as paraneoplastic peripheral neuropathy(PPN).PPN in SCLC appears early,lacks specificity,and often occurs before diagnosis of the primary tumor.It is easy to be misdiagnosed as a primary disease of the nervous system,leading to missed diagnosis and delayed diagnosis and treatment.CASE SUMMARY This paper reports two cases of SCLC with limb weakness as the first symptom.The first symptoms of one patient were rash,limb weakness,and abnormal electromyography.The patient was repeatedly referred to the hospital for limb weakness and rash for>1 year,during which time,treatment with hormones and immunosuppressants did not lead to significant improvement,and the condition gradually aggravated.The patient was later diagnosed with SCLC,and the dyskinesia did not worsen as the dermatomyositis improved after antineoplastic and hormone therapy.The second case presented with limb numbness and weakness as the first symptom,but the patient did not pay attention to it.Later,the patient was diagnosed with SCLC after facial edema caused by tumor thrombus invading the vein.However,he was diagnosed with extensive SCLC and died 1 year after diagnosis.CONCLUSION The two cases had PPN and abnormal electromyography,highlighting its correlation with early clinical indicators of SCLC.
文摘BACKGROUND Colorectal cancer(CRC)ranks high among the most common types of malignant tumors.The primary cause of cancer-related mortality is metastasis,with lung metastases accounting for 32.9%of all cases of metastatic CRC(MCRC).However,cases of MCRC in the lungs,which present concurrently with primary peripheral lung adenocarcinoma,are exceptionally rare.CASE SUMMARY This report describes the case of a 52-year-old female patient who,following a colonoscopy,was diagnosed with moderately differentiated adenocarcinoma based on rectal mucosal biopsy findings.A preoperative chest computed tomography scan revealed a ground-glass nodule in the right lung and a small nodule(approximately 0.6 cm in diameter)in the extramural basal segment of the left lower lobe,which suggested multiple lung metastases from rectal cancer.Subsequent treatment and follow-up led to a diagnosis of rectal cancer with left lung metastasis and peripheral adenocarcinoma of the lower lobe of the right lung.CONCLUSION This case report describes the therapeutic journey of a patient with lung metastasis from rectal cancer in addition to primary peripheral adenocarcinoma,thus underscoring the critical roles of multidisciplinary collaboration,personalized treatment strategies,and comprehensive patient rehabilitation guidance.
文摘BACKGROUND Cervical cancer is a formidable global health issue,particularly affecting women in lower-middle-income countries with little or no access to preventative vaccines,screening programs,and treatment modalities.The case report presents a unique case of a large cervical cancer achieving complete response(CR)with concurrent chemoradiotherapy(CCRT),highlighting the effectiveness of this treatment approach even in advanced stages and underscoring the importance of adaptive radiotherapy(RT)in optimizing patient outcomes.CASE SUMMARY We present the case of a 53-year-old woman who presented with four years of abnormal vaginal bleeding and was found to have p16-positive,moderately differentiated cervical squamous cell carcinoma.The tumor measured 14 cm×12 cm×8 cm,the largest size reported in the literature to achieve CR with CCRT.Despite this monumental feat,the patient remained disease-free and is currently on follow-up for 2 years;however,she continued to suffer from substantial morbidity caused by a vesicovaginal fistula and hydronephrosis,underscoring the continuing impact of cervical cancer on quality of life.CONCLUSION In this case report,we highlight the effectiveness of CCRT in achieving CR,even in cases of bulky cervical cancer,with adaptive RT offering a customized strategy to improve patient outcomes.We also emphasize the necessity for multidisciplinary team discussions and highlight the need for strategies to mitigate treatment-related toxicities and long-term complications.
文摘BACKGROUND The programmed cell death protein 1 inhibitor pembrolizumab has become a key treatment for various cancers,including triple-negative breast cancer.However,it is associated with immune-related adverse events,including rare but serious neurological complications such as Guillain-Barrésyndrome(GBS).GBS is a potentially life-threatening autoimmune disorder characterized by muscle weakness and paralysis.We present a unique case of pembrolizumab-induced GBS to highlight the importance of recognizing this complication and managing it promptly in patients receiving immune checkpoint inhibitors.CASE SUMMARY A 69-year-old woman with a medical history of hypertension,anxiety,depression,and stage IIIB triple-negative breast cancer treated with pembrolizumab,carboplatin,and paclitaxel,presented to the emergency department with a 1-month history of tingling,lower extremity weakness,and shooting pain.Symptoms progressed to global weakness,ascending paralysis,and double vision.Neurological examination revealed significant lower extremity weakness and sensory deficits.Magnetic resonance imaging of the lumbar spine and cerebrospinal fluid analysis confirmed GBS.Initial treatment with intravenous immunoglobulin led to relapse,requiring additional intravenous immunoglobulin and high-dose glucocorticoids.The patient’s condition improved,pembrolizumab therapy was permanently discontinued,and she was discharged to a rehabilitation facility.CONCLUSION Pembrolizumab can induce GBS,necessitating early recognition,prompt diagnosis,and multidisciplinary management to prevent serious complications.
文摘BACKGROUND Multiple primary malignant tumors refer to the occurrence of two or more primary malignant tumors in the same organ or multiple organs or tissues at the same time or successively in the same patient,and can occur anywhere in the body.The treatment guidelines for patients with multiple primary malignant tumors are currently controversial.CASE SUMMARY A 51-year-old male patient with liver cancer and portal hypertension received 42 months of co-treatment with atezolizumab and bevacizumab.After that,the disease was rated stable disease.The patient was then diagnosed with gastric cancer.Since the patient was not sensitive to anti-programmed death ligand 1 immunosuppressive agents,a co-treatment with oxaliplatin,tegafur,apatinib,and cadonilimab was selected after multidisciplinary consultation and the patient’s agreement.After four cycles of treatment,partial response and stable disease were observed in gastric and liver cancers,respectively.Surgical treatment was performed considering the high-risk factors of gastrointestinal bleeding in patients with gastroesophageal varices.Postoperative pathology showed that the Tumor Regression Grade was 1.Moreover,the genetic testing of postoperative tumor specimens indicated negative programmed death ligand 1 and microsatellite stability.In addition,the latest follow-up indicated an 8 and 40-month progression-free survival in gastric and liver cancer patients,respectively.Currently,the patient is receiving postoperative immunotherapy with cadonilimab.CONCLUSION Cadonilimab not only treats microsatellite stability gastric cancer patients but can also be used for liver cancer treatment.
文摘BACKGROUND Colorectal cancer remains as one of the most common cancers that are diagnosed and remains as a significant contributor to morbidity and mortality.Despite advances in techniques,improving access to diagnostic modalities and increasing awareness,it often presents at a later stage and can recur despite treatment.Recurrence can be variable and can occur years after treatment.Liver is the most common location for metastasis to occur followed by lungs.However,atypical sites of metastasis can occur although unusual and colorectal cancer can spread to the spleen,hilum of the liver,adrenals,bone,skeletal muscles,skin,prostate,brain,parotid gland,thyroid gland and even the cardiac muscle.It is crucial to recognize the metachronous nature of the metastasis and to only present at a single site as within this lies the rarity of the case.The mass itself mimicked a cholangiocarcinoma or a Klatskin’s tumor initially and only through pathology was the diagnosis established.We present an unusual case of recurrent colorectal cancer that occurred several years post treatment and presented as an isolated metastasis to the hilum of the liver leading to biliary obstruction without any other identifiable lesions including in the colon itself.CASE SUMMARY A 68-year-old male with history of colon cancer presented with obstructive jaundice to the hospital.After evaluation with imaging studies was diagnosed with mass at the hilum of the liver that was leading to obstruction.With percutaneous biopsies obtained by interventional radiology,the diagnosis of metastatic adenocarcinoma originating from the colon was established.He was deemed not to be a surgical candidate and is currently pursuing chemotherapy.CONCLUSION A metastatic adenocarcinoma of the colon that presents as a hilar mass and mimics cholangiocarcinoma is very rare.The metachronous nature along with the isolated metastasis involving the hilum of the liver makes this case unique.Diagnosis can be challenging and needs a tissue specimen along with immunostaining to achieve an accurate diagnosis and provide appropriate treatment.Biliary decompression is performed either endoscopically or percutaneously and is part of the multidisciplinary approach involving medical and surgical oncology teams.
文摘BACKGROUND Esophageal squamous cell carcinoma(ESCC)is often managed with surgery,which is the first-line treatment option for stage I–III lesions.However,definitive chemoradiotherapy(dCRT)is associated with a recurrence rate of 30%in stage I ESCC and higher rates in advanced-staged lesions.However,several patients prefer dCRT because their general condition is poor.Salvage therapies,including esophagectomy and endoscopic resection[endoscopic submucosal dissection(ESD)/endoscopic mucosal resection],are important for residual or recurrent tumors that develop after dCRT.Esophagectomy can have curative potential.However,it has high complication and mortality rates.Therefore,ESD is a safer alternative.CASE SUMMARY A Japanese man in his 70s was concurrently diagnosed with right hypopha-ryngeal cancer(T2N1M0,cStage III),left oropharyngeal cancer(T1N0M0,cStage I),and left hard palate cancer(T1N0M0,cStage I).Esophagogastroduodenoscopy(EGD)revealed a 20 mm reddish 0-Is+IIb lesion in the upper thoracic esophagus,with an invasion depth of SM2.The lesion was diagnosed as an esophageal mo-derately differentiated squamous cell carcinoma(T1bN0M0,cStage I).As the pharyngeal cancers were in advanced stages,chemoradiotherapy(docetaxel and cisplatin with a radiation dose of 66 Gy)was prioritized.Post-chemoradiotherapy EGD showed that the lesion had flattened into a 0-IIb lesion,thereby indicating a reduced invasion depth(epi-thelium or lamina propria mucosa).ESD achieved en bloc and histologically confirmed curative resection.At 22 months after ESD,the patient did not present with signs of recurrence.CONCLUSION This case emphasizes that ESD can be successfully utilized as a salvage treatment for ESCC after chemoradio-therapy for otolaryngological cancers.
基金Supported by the First Batch of 2024 Social Welfare and Basic Research Projects in Zhongshan City(General Projects in the Field of Healthcare),No.2024B1100Guangdong Provincial Administration of Traditional Chinese Medicine,No.20241357.
文摘BACKGROUND Post-operative massive hemorrhage is a critical concern in oral cancer surgery,associated with severe complications and heightened morbidity and mortality rates.CASE SUMMARY A 46-year-old male with advanced poorly differentiated squamous cell carcinoma(ypT4aN3bN0M0)of the oral floor underwent extensive surgery,including total glossectomy,partial mandibulectomy,and free flap reconstruction.Postoperatively,he developed life-threatening hemorrhage on day 3 due to wound dehiscence.Rapid nursing interventions-prompt suture removal,pressure hemostasis,and multidisciplinary collaboration-controlled bleeding.Postoperative care emphasized hemodynamic monitoring,infection prevention,and rehabilitation.Despite comorbidities(hypertension,diabetes,prior stroke),the patient achieved functional recovery:Oral flap epithelialization,restored swallowing(water swallow test:Grade 1),70% tongue mobility,and 80% preoperative chewing efficiency at 6-month follow-up.This case underscores the critical role of structured nursing protocols in managing postoperative hemorrhage and optimizing outcomes in high-risk oral cancer surgery.CONCLUSION This case report highlights the pivotal role of structured nursing interventions in managing life-threatening postoperative hemorrhage following complex oral cancer surgery.By integrating meticulous preoperative risk stratification,intraoperative hemostatic collaboration,and vigilant postoperative monitoring(e.g.,timely suture management,pressure hemostasis,blood product administration),the interdisciplinary team achieved rapid hemorrhage control.Comprehensive psychological care and rehabilitation protocols further facilitated functional recovery,enabling the patient to regain swallowing,speech,and mobility despite advanced disease and comorbidities.The findings underscore that standardized nursing workflows,balancing procedural rigor with holistic patient support,are essential for mitigating complications and enhancing outcomes in high-risk head and neck surgical populations.
基金The Science and Technology Bureau of Wuhu,Anhui Province,China,Under The Key Research and Development and Achievement Transformation Project,No.2023yf099.
文摘BACKGROUND Breast cancer(BC)metastasis to the gastrointestinal tract is uncommon,colonic metastasis from BC(CMBC)is even rarer.CASE SUMMARY This report describes a 44-year-old female patient with metastatic triple-negative BC in the ascending colon who underwent laparoscopic radical right hemicolectomy.The patient had undergone left modified radical mastectomy only 15 months ago and stopped chemotherapy just 3 months ago.The diagnosis of CMBC was made based on the previous history of BC and positive results of several specific immunohistochemical markers(gross cystic disease fluid protein 15,mammaglobin,GATA-binding protein 3,and cytokeratin 7)for breast carcinoma.CONCLUSION CMBC should be highly cautious in patients with a previous history of BC,especially triple-negative BC,and further examination to aid in diagnosis.
文摘BACKGROUND This article discusses a case involving a 63-year-old man with non-small cell lung cancer,who was treated with a combination of chemotherapy and immunothe-rapy.The patient was treated with five cycles of chemotherapy(pemetrexed and carboplatin)combined with sintilimab,a programmed death 1 inhibitor.CASE SUMMARY After the fifth cycle of treatment,the patient developed skin itching and a vitiligo-like rash,which are known side effects of immunotherapy.Despite dermatologi-cal consultation and treatment with topical corticosteroids,the rash worsened while the itching subsided.The patient continued with the treatment,and after 15 cycles,the tumor showed a response with a reduction in size.The vitiligo-like rash increased,but the antitumor treatment remained effective.CONCLUSION The case highlights the use of immunotherapy in patients with non-small cell lung cancer and the potential side effect of vitiligo-like rash.The patient’s tumor res-ponded well to the treatment,and despite the skin reaction,the treatment was not discontinued due to its effectiveness.The article suggests that further studies are needed to understand the mechanism behind vitiligo in patients with lung cancer receiving immune checkpoint inhibitors and whether the development of vitiligo-like rash after immune checkpoint inhibitor therapy is associated with improved prognosis.The case also underscores the importance of managing immune-related adverse events in the context of effective antitumor treatment.
文摘BACKGROUND Acute pancreatitis(AP)is commonly encountered in gastroenterology,with biliary and alcohol-related causes being predominant.Among less frequent etiologies,metabolic and drug-induced origin are the most prevalent.As an exception,non-pancreatobiliary malignancies may trigger AP,representing less than 1%of cases.We present a case of AP secondary to an uncommon oncologic etiology.CASE SUMMARY We describe the case of a 50-year-old male recently diagnosed with small-cell lung cancer(SCLC).The patient was admitted to the emergency department with acute abdominal pain and subsequently diagnosed with AP.He was hospitalized under the care of the gastroenterology service.During the etiological workup,metastatic pancreatic lesions were identified on imaging,which had not been observed on the initial cancer staging.Following resolution of the initial episode,oral intake was introduced,but the patient experienced recurrent abdominal pain and laboratory abnormalities consistent with new episodes of AP.This pattern repeated over the following days.After several episodes,and with suspicion of a metastatic origin,the case was discussed in multidisciplinary meeting.In agreement with the patient and given the need to initiate treatment for the primary tumor as well,chemotherapy was started.This treatment successfully alleviated symptoms,allowing dietary progression without complications and discharge from the hospital.CONCLUSION Oncologic treatment can be considered as part of the therapeutic approach in AP secondary to SCLC metastasis,especially chemotherapy.
文摘BACKGROUND According to the literature,significant disorders of gut microbiota are consistently observed in patients with colorectal cancer(CRC).Disorders of gut microbiota composition are manifesting clinically as abdominal pain,dyspeptic symptoms(such as rumbling,bloating,and altered bowel habits,including both constipation and diarrhea),and overall reduced quality of life.Also,negative changes in the microbiota may be associated with a more frequent development of postoperative complications and complications during chemotherapy.CASE SUMMARY Two patients with CRC underwent surgery(laparoscopic left hemicolectomy)and were prescribed chemotherapy regimen consisted of cisplatin,leucovorin,and fluorouracil.Along with prescribed chemotherapy patients took autoprobiotic enterococci.A fecal sample was collected for autoprobiotic preparation,ensuring that the patient had not taken antibiotics,probiotic supplements,or probiotic-containing foods for at least 10 days.An autoprobiotic contained an indigenous strain of Enterococcus faecium(E.faecium)was formulated.The patients received the autoprobiotic strain E.faecium(liquid form with a concentration of 8 Lg CFU/mL)orally at a dose of 50 mL twice daily during 10 days,regardless of meal times,from the first day of cytostatic treatment,throughout the first course of chemotherapy.As a result,autoprobiotic intake improved patient well-being and prevent side effects associated with the use of cytostatics.CONCLUSION The use of autoprobiotics in the treatment of CRC is a promising area to reduce the risks of postoperative complications,increase the tolerability of the basic chemotherapeutic regimen,as well as improve the quality of life.
文摘BACKGROUND The 5-year survival rate for patients with pancreatic cancer(PC)is 4%-12%.Surgery is the only treatment that offers curative potential,but only 15%-20%of patients are eligible for surgery.PC is prone to recurrence and metastasis,and the antitumor effect of chemotherapy is notably limited.CASE SUMMARY Histopathological analysis of a 53-year-old female PC patient who underwent Whipple surgery revealed poorly differentiated tumor cells infiltrating nerves,lymphatics,and blood vessels.The patient received two different first-line chemotherapy regimens consecutively;however,both regimens struggled to control disease progression.During this period,the patient underwent liver metastasis ablation surgery,Candida albicans liver abscess,and stereotactic body radiotherapy.With the addition of camrelizumab to the modified FOLFIRINOX regimen,tumor control was achieved.The patient subsequently refused to continue chemotherapy,and the antitumor regimen was changed to a combination of camrelizumab and apatinib.After patients received a combination of immunotherapy and targeted therapy,the length of hospital stay was significantly reduced.Furthermore,all side effects were within acceptable limits,leading to an improved quality of life and prolonged progression-free survival.Unfortunately,the pain associated with cancer,coupled with the side effects of opioid analgesics,has led the patient to reject all available anticancer treatment options.Approximately one month after camrelizumab and apatinib were discontinued without medical authorization,the PC recurred and rapidly progressed to widespread metastasis,ultimately leading to the patient's death approximately one month later.The overall survival was 2 years.CONCLUSION Immunotherapy and targeted therapy have the potential to increase both the quality of life and survival time of PC patients,particularly those whose tumor progression is not effectively controlled by chemotherapy alone.Nevertheless,further clinical trials are necessary to validate these findings.
基金Supported by the Innovation Platform and talent program of Hunan Province,No.2021SK4050the Natural Science Foundation of Hunan Province,No.2023JJ30608 and No.2023JJ30609.
文摘BACKGROUND Colon cancer is a common malignancy of the digestive tract.An estimated 1148515 new cases of colon cancer were reported in 2020 worldwide.Chronic myeloid leukemia(CML)is a malignant tumor formed by the clonal proliferation of bone marrow hematopoietic stem cells,with an annual incidence rate of 1-2 cases per 100000 people worldwide.Leukemia can be secondary to solid tumors,and vice versa.Reports on CML secondary malignant tumors account for 8.7% but CML secondary to malignancy is extremely rare.Therapy-related CML is a rare but potentially fatal adverse event of chemotherapy or radiotherapy.Herein,we report a case of CML with colon cancer and discuss this unique patient popu-lation.Our findings can provide effective raw data and guidance for the diagnosis of this clinical disease.CML in patients with colon cancer is extremely rare.Secondary hematological tumors may be multifactorial,and the exact mechanism is currently unknown.Owing to the slow progression of the disease,patients with CML show no sy-mptoms in the early stage.However,with disease progression,obvious but non-specific symptoms may appear,including fever,anemia,bleeding tendency,and hypertrophy.Therefore,complete blood count monitoring for routine examination is recommended after cancer treatment for early detection of occult hematological tumors.
文摘BACKGROUND Treatment of metastatic gastric cancer(mGC)relies primarily on chemotherapy,which can be effectively combined with immunotherapy.Despite these interventions,overall survival remains suboptimal.CASE SUMMARY We report a patient with mGC who received S-1 plus oxaliplatin with sintilimab as first-line therapy,followed by maintenance therapy with S-1 and sintilimab.After 6 months,a partial response was observed,with a 71.7%reduction in the target lesion.After 13 months,the reduction reached 76.3%.Treatment was temporarily paused for 6 months due to a pulmonary infection.Upon re-evaluation 6 months later,the tumor continued to regress,with a 79.4%reduction in the target lesion.The original regimen was then resumed.From diagnosis to date,progression-free survival has reached 23 months.CONCLUSION Sintilimab combined with chemotherapy demonstrated improved progressionfree survival and warrants further investigation in mGC.
文摘BACKGROUND Gastric cancer is the fifth most common cancer and the fourth leading cause of death worldwide.Most cases of newly diagnosed gastric cancer involve not only locally advanced tumor growth and regional lymph node metastases but also distant metastases.We report a rare case finding of a mass in the right inguinal area which is derived from gastric cancer.CASE SUMMARY A 68-year-old male initially diagnosed with an inguinal hernia presented with a 2 cm mass in the right inguinal area.Gastrointestinal symptoms led to the discovery of a stomach tumor.Biopsy confirmed gastrointestinal adenocarcinoma.The diagnosis was advanced gastric cancer with peritoneal dissemination,and the inguinal mass was due to direct infiltration.Due to gastrointestinal bleeding,the patient underwent palliative gastrectomy and lymph node dissection.Postoperatively,the patient received hyperthermic intraperitoneal chemotherapy and localized radiation therapy.CONCLUSION This case indicates that a systematic evaluation should be conducted during the initial consultation to explore the potential connection between unrecognized distant masses and the primary tumor.
