Alessio Piraino

Lung cancer and concurrent or sequential lymphoma: Two case reports with hypersensitivity to bevacizumab and a review of the literature

Non-small cell lung cancer (NSCLC) accounts for ~80% of all cases of lung cancer, and is the leading cause of cancer-related mortality worldwide. The majority of NSCLC cases of are diagnosed at an advanced stage. The outcome of patients with advanced NSCLC is poor with a median survival time of ~12 months in European and American populations. Lymphoproliferative disorders (LPDs) represent a heterogeneous group of expanding lymphoid cells, which occurs as a result of immune dysfunction. LPDs are often associated with primary solid cancers. We report two cases of LPD diagnosed concurrently and successively to NSCLC. The first case presents a 65-year-old female patient with advanced IV stage lung cancer, according to the International Association for the Study of Lung Cancer TNM staging system. The patient developed a concurrent lymphoma and was treated with first-line therapy including six cycles of gemcitabine and cisplatin, however, the patient experienced an adverse drug reaction to bevacizumab, which was administered after gemcitabine and prior to cisplatin. The second case presented a 74-year-old male patient diagnosed with large B cell lymphoma. The patient acheived remission of the illness, however, after one year the patient was diagnosed with squamous cell lung cancer. After three years, the patient underwent surgery, however disease recurrence was identified. Subsequently, the patient was treated with sterotactic radiotherapy and oral chemotherapy. A review of the associated literature was also conducted.

Successful multimodal treatment of a breast cancer patient with a recurrence invading the chest wall.

Abstract We describe successful operative management of a solitary breast cancer metastasis in the chest wall after complete response with concomitant non-pegylated liposomal doxorubicin (NPLD) and docetaxel followed by sternal rib resection with prosthetic reconstruction. We report a case of a 41-year-old woman who had a breast cancer recurrence infiltrating neighboring osteo-cartilage of the left sternal body, the cartilaginous portion of the third and fourth ipsilateral ribs and was inseparable from the rear side pectoral reaching deep into contiguity with the pericardium. After 6 cycles of chemotherapy with NPLD plus docetaxel, sternal rib resection with prosthetic reconstruction was performed. Histological examination did not show any evidence of residual tumor. At 9 months of follow-up, the patient appears free of disease. Our case demonstrates that a multimodal approach in patients with chest wall recurrence of breast cancer without distant metastasis, may be safe and effective for maintaining a good quality of life.

Symptom-free T4 lung cancer with bilateral pulmonary artery infiltration.

Correspondence to: Dr Alfredo Cesario, Division of General Thoracic Surgery, Catholic University, Largo Agostino Gemelli, 8, 00168 Rome, Italy alfcesario@rm.unicatt.it A 71-year-old man with a history of pulmonary tuberculosis and right fibrothorax was admitted to hospital for persistent haemoptysis. Because of the underlying deformity, interpretation of the chest radiograph was difficult (figure A). Physical examination showed an asymmetry of the right hemithorax; routine blood tests were unremarkable. Performance status was good (Eastern Cooperative Oncology Group [ECOG] 0–1). Assessment of function showed only a moderate reduction in forced expiratory volume in 1 s (FEV1, 67% of predicted) and PaO2 (82% in air). Bronchoscopy showed a stenosis of the intermediate bronchus with normal mucosa. Biopsies were undertaken. CT showed a huge hilar and mediastinal mass infiltrating the heart and the pulmonary artery on both sides (figure B). To the best of our knowledge, no other reports have been made of such a discrepancy in the clinical, radiological, and morphological status in such extensive mediastinal involvement. Pathological analysis was consistent with non-small-cell lung adenocarcinoma. Surgery was not indicated, and medical treatment was planned (single agent gemcitabine-based chemotherapy plus supportive care). 5 months after diagnosis the patient is alive with an acceptable performance and quality-of-life status. Symptom-free T4 lung cancer with bilateral pulmonary artery infiltration