BJMO - volume 18, issue 7, november 2024
Y. Vanbiervliet MD, H. Vandekerckhove MD, N. Van Tittelboom MA, V. Neyrinck MD, V. Renard MD, S. De Waele MA
This case report discusses a 76-year-old woman with a history of epilepsy and cerebral aneurysms who underwent surgical intervention for stage III malignant melanoma and subsequently received pembrolizumab as adjuvant immunotherapy. Four weeks post-treatment initiation, she presented with unilateral ptosis and was diagnosed with a complex immune-related adverse event involving myocarditis, myositis, and myasthenia gravis, termed the triple M syndrome. The patient exhibited elevated cardiac and muscular biomarkers, deranged liver enzymes, hypothyroidism, severe aortic valve insufficiency, and decreased systolic function. Comprehensive diagnostic assessments ruled out structural abnormalities and ischaemic disease, prompting the initiation of high-dose IV corticosteroids. The patient’s clinical course involved steroid resistance, necessitating an escalation of corticosteroids and the introduction of mycophenolic acid as second-line immunosuppressive therapy. A positive evolution was observed with a resolution of ptosis and improvement of cardiac biomarkers, including troponin levels, leading to successful discharge.
(BELG J MED ONCOL 2024;18(7):279–281)
Read moreBJMO - volume 18, issue 6, october 2024
A. Bouzidi Ilias MD, F. Bosmans MD, A. Van Beeck MD, D. Schrijvers MD, PhD
Presacral myelolipomas are exceedingly rare benign tumours composed of mature adipose tissue and haematopoietic elements. Here, we present a case report of an 81-year-old male with a complex medical history, who presented with recurrent disabling back pain and haematuria. Initial evaluation showed a presacral lipomatous mass, raising concerns of a liposarcoma. Multidisciplinary discussion raised the possibility of a presacral myelolipoma and suggested a nuclear scan for confirmation of this diagnosis. Given the absence of symptoms due to the presacral mass and patient comorbidities, a watchful waiting approach was adopted. This case underscores the diagnostic challenges associated with presacral masses, emphasising the necessity for accurate identification to guide optimal management strategies. Heightened awareness among clinicians and radiologists is crucial for timely and accurate management decisions in such cases. This report contributes to the existing literature by highlighting the diagnostic process and management of this rare entity.
(BELG J MED ONCOL 2024;18(6):239-243)
Read moreBJMO - 2024, issue 3, may 2024
L. Decraene MD, H. Van Hoecke MD, PhD, C. Braet MD, E. Humble MD, C. Jacobs MD, M. Saerens MD, D. Stevens MD, I. Dhooge MD, PhD
Immune checkpoint inhibitors (ICI) are an increasingly used form of cancer immunotherapy (IT) with improved overall survival and efficacy compared to conventional chemotherapies in advanced cancers like non-small cell lung carcinoma (NSCLC) and melanoma. However, immune-related adverse events (irAEs) are still common and can be severe. In rare cases, inner ear irAEs have been reported. A pilot prospective longitudinal study was conducted in thirteen patients with melanoma or NSCLC treated with an ICI. A questionnaire based on the Speech, Spatial, and Qualities of Hearing Scale (SSQ), the Health Utilities Index Mark 2 and Mark 3 (HUI2/3), and the So Stoned questionnaire was used in conjunction with audiovestibular testing at baseline, three and six months. Seven out of thirteen patients showed irAEs. Despite inner ear irAE being rare, this study identified one patient with acute bilateral hearing loss within the study group of thirteen patients. Due to the increased use of immunotherapy, it is expected that the number of patients with acute inner ear pathology will rise. In this regard, awareness can lead to prompt diagnosis and treatment, as well as a better understanding of the pathophysiology and incidence of audiovestibular irAE.
(BELG J MED ONCOL 2024;18(3):89–94)
Read moreBJMO - volume 18, issue 2, march 2024
L. Verbeke MD, E. Roussel MD, PhD, C. Maes MD, K. Coppens MD
Renal tumours are often incidentally detected in routine imaging studies. Whereas renal cell carcinoma (RCC) represents the mainstay of malignant tumours arising from the kidney, other tumoural entities might also present as a single, localised renal mass. Primary renal lymphoma (PRL) is a distinct, rare and often aggressive presentation of lymphoma confined to the kidney, often mistaken for RCC or other renal tumours. It is defined as a non-Hodgkin lymphoma of the kidney without any extra renal lymphatic disease. Symptoms are often haematuria or flank pain. In 50% of the cases, patients are asymptomatic. The pathophysiology is not well understood. Imaging can be helpful in making the right diagnosis, but renal mass biopsy appears to be more sensitive. The treatment of choice is chemotherapy. The prognosis is rather poor, with a median survival of less than one year. Since the introduction of the new chemotherapy combination with rituximab, the prognosis is slightly better. PRL needs to be a differential diagnosis in renal tumours, especially with atypical tumour characteristics. This article presents a recent case of primary renal lymphoma.
(BELG J MED ONCOL 2024;18(2):60–64)
Read moreBJMO - volume 18, issue 1, february 2024
D. Schrijvers MD, PhD, L. Velthof MD, K. De Boeck MD, M. Al Saddi MD, V. De Groot MD, PhD
This case report describes a patient with a lacrimal tumour and distant bone lesions. The diagnosis of an IgG4-related pseudo tumour of the lacrimal gland with involvement of the skeleton was made. A review of lacrimal gland lesions and IgG4-related disease is given. The oncologist should be aware of this entity and it should be included in the differential diagnosis of lacrimal gland lesions.
(Belg J Med Oncol 2024;18(1):24–8)
Read moreBJMO - volume 17, issue 7, november 2023
M. De Wit MD, L-A-F. Clifton MD, E. Beuckelaers MD, J. Desimpelaere MD, D. Schrijvers MD, PhD
This article presents the case of a 35-year-old patient with a glomus tumour in the fourth digit of the right hand. The patient had a history of a bilateral embryonal testicular carcinoma, which was treated with surgery and chemotherapy. The initial complaints consisted of pain in all the fingers on the right hand, suspected of Raynaud phenomenon. Finally, the diagnosis was made clinically and through magnetic resonance imaging. He underwent surgery to remove the tumour, and the diagnosis was pathologically confirmed. The treatment was curative, and the complaint of pain resolved.
(Belg J Med Oncol 2023;17(7):264–6)
Read moreBJMO - volume 17, issue 4, june 2023
E. van Gogh MD, L. Baisier MD, P. Reyntiens MD, J. Liu MD, M. Rasschaert MD, PhD
Immunotherapy has revolutionised cancer therapy for specific tumour types. The dismal prognosis of melanoma patients with advanced stage has improved but remains poor. With the increasing use of these monoclonal antibodies, toxicities are becoming more prevalent. Neurological adverse events are still rare but have an enormous impact on the continuum of care. This study reports a case of a 70-year-old man with stage IIIc melanoma who presented with cerebral vasculitis after rechallenge therapy with ipilimumab/nivolumab.
(Belg J Med Oncol 2023;17(4):128–31)
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