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Yang H, Yuan R, Alex D, Hughesman C, Liu S, Lee U, Zhou C, Wang G. Metastatic Small Bowel Adenocarcinoma Mimicking a Primary Ovarian Mucinous Tumour - Clinical, Radiologic, Pathologic and Molecular Correlation. Int J Surg Pathol 2023; 31:110-118. [PMID: 35477328 DOI: 10.1177/10668969221098083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
We describe an interesting case of a patient who presented with a large adnexal mass, first favored to be mucinous carcinoma of the gynecologic origin. The primary tumour site was ascertained after the patient's small bowel was resected by identifying an adenomatous component evolving into an invasive adenocarcinoma identical in morphology and immunophenotype to the ovarian tumour. Notably, both tumours were found to harbor a BRAF K601E mutation, which is extremely rare for a primary of the ovary. BRAF mutations are present in a subset of large bowel and small bowel adenocarcinoma, but our case shows the first instance of a BRAF K601E mutation being present in a small bowel adenocarcinoma, to the best of our knowledge. This case serves as a great illustration of the pivotal role of molecular diagnostics in modern pathology in arriving at the correct diagnosis. Additionally, it is an excellent example of how clinical-radiologic-pathologic-molecular correlation plays into the landscape of molecular pathology to deliver optimal care for the patient.
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Affiliation(s)
- Hang Yang
- Department of Pathology and Laboratory Medicine, BC Cancer, 8144University of British Columbia, Vancouver, V6 T 2B5, Canada
| | - Ren Yuan
- Department of Radiology, BC Cancer, 8144University of British Columbia, Vancouver, V6 T 2B5, Canada
| | - Deepu Alex
- Department of Pathology and Laboratory Medicine, BC Cancer, 8144University of British Columbia, Vancouver, V6 T 2B5, Canada
| | - Curtis Hughesman
- Department of Pathology and Laboratory Medicine, BC Cancer, 8144University of British Columbia, Vancouver, V6 T 2B5, Canada
| | - Shiru Liu
- Department of Oncology, BC Cancer, 8144University of British Columbia, Vancouver, V6 T 2B5, Canada
| | - Ursula Lee
- Department of Oncology, BC Cancer, 8144University of British Columbia, Vancouver, V6 T 2B5, Canada
| | - Chen Zhou
- Department of Pathology and Laboratory Medicine, BC Cancer, 8144University of British Columbia, Vancouver, V6 T 2B5, Canada
| | - Gang Wang
- Department of Pathology and Laboratory Medicine, BC Cancer, 8144University of British Columbia, Vancouver, V6 T 2B5, Canada
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Sacdalan DB, Mendoza MJ, Vergara JP, Catedral LI, Ting FI, Leones LM, Berba CM, Sacdalan DL. Beyond bevacizumab: a review of targeted agents in metastatic small bowel adenocarcinoma. Med Oncol 2020; 37:106. [PMID: 33135102 DOI: 10.1007/s12032-020-01432-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Accepted: 10/23/2020] [Indexed: 12/14/2022]
Abstract
Small bowel cancers are rare tumors with an incidence 50-100-fold less than colorectal cancer. These tumors carry a poor prognosis. Owing to its rarity, treatment of this disease, particularly in its advanced stages, has not been optimized and is derived mainly from treatment regimens for colorectal cancer. Based on recent studies bevacizumab, an antibody directed against vascular endothelial growth factor and used in the management of metastatic CRC, has been added to treatment guidelines for metastatic small bowel adenocarcinoma. We investigate in this review the evidence behind other targeted treatments that may be beneficial in the treatment of metastatic small bowel adenocarcinoma. These are agents against EGFR, VEGFR-2, HER2, and NTRK as well as immune checkpoint inhibitors. The last class of drugs appears to hold the greatest promise based on the preponderance of evidence supporting its use. However, overall data remains sparse. Results of studies currently underway will be valuable in shedding more light on the management of this aggressive cancer.
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Affiliation(s)
- Danielle Benedict Sacdalan
- Department of Pharmacology and Toxicology, University of the Philippines Manila College of Medicine, Pedro Gil Street, Manila, 1000, Philippines. .,Division of Medical Oncology, Department of Medicine, Philippine General Hospital and University of the Philippines Manila, Taft Avenue, Manila, 1000, Philippines.
| | - Marvin Jonne Mendoza
- Division of Medical Oncology, Department of Medicine, Philippine General Hospital and University of the Philippines Manila, Taft Avenue, Manila, 1000, Philippines
| | - John Paulo Vergara
- Division of Medical Oncology, Department of Medicine, Philippine General Hospital and University of the Philippines Manila, Taft Avenue, Manila, 1000, Philippines
| | - Lance Isidore Catedral
- Division of Medical Oncology, Department of Medicine, Philippine General Hospital and University of the Philippines Manila, Taft Avenue, Manila, 1000, Philippines
| | - Frederic Ivan Ting
- Division of Medical Oncology, Department of Medicine, Philippine General Hospital and University of the Philippines Manila, Taft Avenue, Manila, 1000, Philippines
| | - Louis Mervyn Leones
- Division of Medical Oncology, Department of Medicine, Philippine General Hospital and University of the Philippines Manila, Taft Avenue, Manila, 1000, Philippines
| | - Carlo Miguel Berba
- Division of Medical Oncology, Department of Medicine, Philippine General Hospital and University of the Philippines Manila, Taft Avenue, Manila, 1000, Philippines
| | - Dennis L Sacdalan
- Division of Medical Oncology, Department of Medicine, Philippine General Hospital and University of the Philippines Manila, Taft Avenue, Manila, 1000, Philippines
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Ileal Adenocarcinoma with Liver Metastasis in Patient with Crohn's Disease: A 9-Year Survival. Case Rep Oncol Med 2019; 2019:8473829. [PMID: 31485362 PMCID: PMC6710734 DOI: 10.1155/2019/8473829] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 06/27/2019] [Accepted: 07/24/2019] [Indexed: 11/29/2022] Open
Abstract
Small bowel adenocarcinoma is a rare but well-known complication of Crohn's disease. The diagnosis of small bowel adenocarcinoma remains difficult since its presentation is highly variable and mimics active or obstructive Crohn's disease. The diagnosis is often delayed and typically detected only at surgery in an advanced stage with a poor prognosis. We report a case of metastatic ileal adenocarcinoma in a patient with Crohn's disease with prolonged survival. Our case describes serial promising treatment options of these advanced malignancies and raises a possible role for checkpoint immunotherapy.
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