ONCOCASE

Bone lytic lesion: breast cancer metastase or sarcoidosis? A case-report

The authors present the case of a 47 year old woman with a history of a primary breast cancer and local recurrence, who developed disseminated pulmonary lesions, supra- and infra-diaphragmatic adenopathies and a lytic lesion of the right iliac bone nine years later. The diagnosis of disseminated carcinomatosis was initially suspected but a targeted bone biopsy surprisingly revealed the presence of sarcoidosis typical lesions. In this case, none of the sophisticated imaging tools could provide an accurate differential diagnosis. Thus for such cases, an anatomo-pathological analysis is definitively mandatory in order to avoid overtreating patients without evolutive cancer.

(BELG J MED ONCOL 2014;8(1):1–7)

Myeloid sarcoma or lymphoblastic lymphoma? A closer look at the laboratory diagnosis

Summary

Although a myeloid sarcoma is a rare form of extramedullary leukaemia, its early diagnosis has been proven to be of utmost importance. Its presence is strongly related to the onset or the presence of systemic bone marrow leukaemia. However, the diagnosis of myeloid sarcoma is not straightforward. In the existing literature, approximately half of the cases of myeloid sarcoma were initially misdiagnosed as lymphoma. The current case reports details on the laboratory diagnosis of myeloid sarcoma in a 25-year old male. The laboratory presentation of myeloid sarcoma and the consecutive steps in order to correctly diagnose myeloid sarcoma using a variety of laboratory techniques including microscopy, flow cytometry and cytogenetics are highlighted.

(BELG J MED ONCOL 2013;7(4):119–22)

Case report: squamous cell carcinoma of the breast, a rare cancer?

Summary

We present the case of a 56-year old patient with primary squamous cell carcinoma of the breast. She underwent a radical mastectomy with adjuvant chemotherapy, consisting of carboplatinum and gemcitabine, and consecutive radiotherapy. Twenty-seven months after her treatment she is still disease-free. Hormonal therapy was initiated for a small tubular carcinoma and is continuing. As yet, there is uncertainty about the correct management of this rare and aggressive type of cancer, but there is growing evidence that adjuvant platinum-based regimens, especially cisplatinum, might be effective in inducing long-term complete remission.

(BELG J MED ONCOL 2013;7(3):89–92)

Haemolytic uraemic syndrome culminating in terminal renal failure after gemcitabine treatment: case report and literature survey

Summary

We report the case of a woman treated for an ovarian cancer who ultimately developed terminal renal failure in the frame of a haemolytic uraemic syndrome induced by prolonged gemcitabine therapy. This case illustrates the need of a systematic screening for haemolytic uraemic syndrome in patients receiving protracted gemcitabine for over three months.

(BELD J ONCOL MED 2013;7(2):50–52)

Impressive response to eribulin in endocrine- and chemotherapy-resistant metastatic breast cancer

Summary

We present the case of an 81-year-old woman with a past history of hormone receptor-positive breast cancer of the left breast, who underwent mastectomy followed by radiotherapy in 1989 and who was treated with five years of adjuvant tamoxifen. Ten years later she experienced a local relapse and was treated with different lines of endocrine and chemotherapy without any success. After discussion of her case in a multidisciplinary team, eribulin was proposed. Eribulin is a new type of microtubule dynamics inhibitor and is a synthetic analogue of halichondrin B, which was isolated from a marine sponge. It has been tested in patients with locally recurrent or metastatic disease and has shown a survival benefit when compared to treatment of physician’s choice (TPC; any single-agent chemotherapy or hormonal or biological treatment approved for the treatment of cancer, radiotherapy or symptomatic treatment). In the international Phase III Eisai Metastatic Breast Cancer Study Assessing Physician’s Choice Versus Eribulin (EMBRACE) trial. The total median overall survival for women treated with eribulin was 13.1 months compared to 10.7 months for TPC. These results could potentially establish eribulin as a new treatment standard for this particular group of patients.

(BELG J MED ONCOL 2013;7:27–30)

Giant cell tumour of the jaw: a new hope for a difficult-to-treat disease

Recurrent giant cell tumour of the bone is a difficult to treat and mutilating disease. A patient with a recurrent giant cell tumour of the jaw is reported. He received multiple treatments with surgery and bisphosphonates. Due to progressive disease he was treated with denosumab with good result. An overview of giant cell tumour of the bone is given. (BELG J MED ONCOL 2012;6:201–203)

Treatment of non-small cell lung carcinoma with gefitinib: a case report

Targeted therapy for non-small cell lung carcinoma (NSCLC) is a possible treatment option for patients with tumours expressing an activating mutation of the epidermal growth factor receptor (EGFR). Gefitinib is an epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor (TKI) that was approved for treatment of EGFR mutation-positive NSCLC in Europe in 2009. In Belgium, gefitinib was only approved as a monotherapy for EGFR mutation-positive NSCLC stage IIIB-IV, whatever the line of treatment. When treatment was initiated, limited data were available relating to the use of TKIs for treating Caucasian patients with EGFR mutation-positive NSCLC. Thus, information on EGFR TKI use, in the real-life clinical setting and particularly in Caucasian patients and patients with brain metastases is still needed. Here, we report the case of a patient with NSCLC and brain metastases being treated with gefitinib.

After twelve months of treatment, the chest and brain scans still showed improvement with lung function normalising and the patient reporting a good quality of life. As this patient was not previously treated with chemotherapy, there is still an opportunity of treating her later, when the tumour becomes resistant to gefinitib, with cisplatinum-pemetrexed. This is still possible because she remains chemotherapy-naive, which is required to request reimbursement in Belgium of that type of chemotherapy. (BELG J MED ONCOL 2012;6:169–175)