ONCOCASE

5-Fluorouracil-induced pericarditis: case report and literature survey

Summary

5-Fluorouracil is an antimetabolite frequently used in the treatment of digestive cancers. Outside well-known side effects, it may induce cardiac toxicity under various clinical forms, from chest pain to arrhythmia, or even cardiac arrest, pericarditis being one of the most uncommon.^1,2 We report here the case of a 52-year-old man who developed pericarditis symptoms after continuous 5-fluorouracil infusions.

(BELG J MED ONCOL 2016;10(1):35–37)

Prostatopubic fistula and osteomyelitis of the pubic bone as severe complication after salvage high intensity focused ultrasound for prostate cancer: report of two cases

Summary

High-intensity focused ultrasound has been used as an alternative treatment for prostate cancer, as both primary or salvage treatment. It is considered a minimally invasive treatment modality. We recently needed to care for two patients with severe osteomyelitis of the pubic bone as a result of a prostatopubic fistula, after they underwent salvage high-intensity focused ultrasound treatment post-radiotherapy.

(BELG J MED ONCOL 2015;9(7):290–95)

Carboplatin-Paclitaxel chemotherapy and general anaesthesia in an ovarian cancer patient: a combination to provoke reversible posterior leukoencephalopathy syndrome?

Summary

Reversible posterior leukoencephalopathy syndrome is a syndrome of heterogeneous aetiology characterised by typical clinical and radiological findings. The occurrence of reversible posterior leukoencephalopathy syndrome in cancer patients is rapidly increasing. So when a cancer patient suddenly experiences symptoms of altered consciousness, convulsions, headache and/or visual disturbances, reversible posterior leukoencephalopathy syndrome should always be included in the differential diagnosis. In this paper, we describe a case of a patient who developed reversible posterior leukoencephalopathy syndrome after receiving a regimen with carboplatin and paclitaxel.

(BELG J MED ONCOL 2015;9(7):286–89)

5-Fluorouracil-induced coronary vasospasm: case report and discussion

5-Fluorouracil is one of the most widely used chemotherapeutic agents. It has been included in the treatment of a number of solid tumours, including upper gastrointestinal, colorectal and breast cancer, for many years. It is the backbone of several chemotherapy regimens, particularly in the treatment of gastrointestinal tract adenocarcinomas. Unfortunately, cardiotoxicities may be expected to occur regularly. As 5-fluorouracil is widely used, cardiotoxicity due to 5-fluorouracil is a relatively common problem. The case of a 64-year old man with invasive intestinal adenocarcinoma, who developed chest pain during his first mFOLFOX cycle, is presented. We see in this case and in the literature that recurrence of cardiac toxicity is high, even with premedication. There is some evidence that replacing the fluoropyrimidine by raltitrexed is safe and efficacious for patients with 5-fluorouracil (cardiac) toxicity in the setting of colorectal cancer.

(BELG J MED ONCOL 2015;9(5):194–98)

Incidental finding of prostate cancer in patients treated with benign prostatic hyperplasia (BPH)

In this case report we describe the incidental finding of prostate cancer in a patient undergoing a transurethral prostate resection for benign prostatic hyperplasia and discuss the diagnostic and treatment approach of this patient group.

(BELG J MED ONCOL 2015;9(3):104–6)

Angioedema of the tongue in a patient with breast carcinoma treated with exemestane-everolimus in combination with an angiotensinconverting enzyme inhibitor

This report describes the case of a patient with metastatic breast cancer that was treated with exemestaneeverolimus and who developed unilateral angioedema of the tongue as an adverse effect due to the combination of everolimus and an angiotensin-converting enzyme inhibitor. Since high doses of everolimus are used in the treatment of more common malignancies such as advanced renal cell and breast cancer, an increase in the occurrence of this potentially severe adverse effect can be expected. We recommend carefully looking into the current medication list of the patient before starting everolimus and when an angiotensin-converting enzyme inhibitor is present, it should be replaced by an alternative antihypertensive drug until more data become available. That way treatment discontinuation or dose reduction of anticancer treatment can be avoided.

(BELG J MED ONCOL 2015;9(2):71–3)

Mixed adenoneuroendocrine carcinoma (MANEC) of the colon: molecular pathogenesis and treatment

We present the case of a 30-year-old male patient with a high grade neuroendocrine carcinoma and an adenocarcinoma developed in a tubulovillous adenoma of the colon, with diffuse liver metastasis. He underwent a right hemicolectomy and received four courses of postoperative chemotherapy with cisplatin and etoposide, followed by high dose chemotherapy with autologous stem cell support. After this treatment there was a complete biochemical and radiological remission. Now, 48 months after diagnosis the patient is alive and in unmaintained complete remission. The occurrence of a high grade neuroendocrine carcinoma in a low grade colon adenocarcinoma without any intermediate phenotypes was intriguing. Comparative exome sequencing of DNA from the malignant components revealed six somatic changes in cancer consensus genes. In both tumours, we detected mutations in APC and KRAS, as well as in BCL9 and FOXP1. Only in the neuroendocrine carcinoma component did we find a mutation in SMARCA4. All mutations were absent in germ-line DNA. The finding of several identical somatic mutations in both components in the subsequent exome sequencing supports a clonal relationship between the neuroendocrine carcinoma and the synchronous adenocarcinoma. We suggest that a mutation in SMARCA4A may be responsible for the abrupt transition to the aggressive neuroendocrine phenotype.

(BELG J MED ONCOL 2015;9(1):31–34)