levoleucovorin and Thyroid-Neoplasms

We describe the case of a 72-year-old woman with locally advanced lung tumor mimicking primary lung cancer. She was diagnosed with rectal cancer at the age of 65 years and was initially treated with platinum-based chemotherapy and thoracic irradiation as a treatment for primary lung cancer. One year later, a thyroid tumor was detected in her right thyroid lobe and was confirmed to have metastasized from rectal cancer based on pathological findings. Therefore, we suspected that she had metachronous double cancers and treated her with conventional chemotherapy for colorectal cancer. However, new life-threatening multiple lung metastases appeared. We treated her with the drug erlotinib because additional genetic analysis against primary lung tumor revealed typical double-activating epidermal growth factor receptor mutations. Histological review by immunostaining concluded that the primary lung tumor was composed of metastatic tumors from rectal cancer. In addition, genetic analysis revealed that the primary rectal cancer contained nearly the same types of double-activating epidermal growth factor receptor mutations as were present in the lung tumor. This is the first report of a case of rectal adenocarcinoma with double-activating epidermal growth factor receptor mutations.

Topics: Adenocarcinoma; Aged; Antineoplastic Agents; Antineoplastic Combined Chemotherapy Protocols; Biomarkers, Tumor; Camptothecin; Colorectal Neoplasms; DNA Mutational Analysis; ErbB Receptors; Erlotinib Hydrochloride; Female; Fluorouracil; Humans; Immunohistochemistry; Leucovorin; Lung Neoplasms; Mutation; Neoplasms, Second Primary; Organoplatinum Compounds; Quinazolines; Thyroid Neoplasms; Transcriptional Activation; Treatment Failure; Treatment Outcome

Metastatic urachal cancer is a rare disease and subsequently, does not have a defined systemic treatment. Although urachal cancer is most commonly adenocarcinoma and histologically similar to colon cancer, treatment selection is usually based upon location (the proximity of the urachus to the bladder) with bladder cancer regimens the most commonly prescribed. We report a case of metastatic urachal cancer where the immunohistochemical profile's similarities to colon cancer led to treatment with colon cancer specific chemotherapy. Our case is the first to report urachal cancer treated with and responding to modified FOLFOX6. In the age of targeted therapy, where molecular biology drives treatment selection, our case highlights that in rare tumors, when evidence is often lacking, a common sense approach can often prevail.

Topics: Adenocarcinoma; Antineoplastic Combined Chemotherapy Protocols; Combined Modality Therapy; Cystectomy; Fluorouracil; Humans; Leucovorin; Lung Neoplasms; Male; Middle Aged; Organoplatinum Compounds; Thyroid Neoplasms; Treatment Outcome; Urachus; Urinary Bladder Neoplasms

We present a patient with colon carcinoma metastatic to the thyroid. Review of the literature reveals only a few reports of metastatic colorectal carcinoma to the thyroid. Metastatic tumors of the thyroid are no longer considered rare. Unfortunately, they often remain undetected because only a small minority of patients present with a mass lesion or enlargement of the gland. This is further evidenced by the fact that most reports come from autopsy series. Establishing this diagnosis is important because metastatic deposits in the thyroid can sometimes cause respiratory compromise as well as thyrotoxicosis.

Topics: Adenocarcinoma; Antineoplastic Combined Chemotherapy Protocols; Bone Neoplasms; Camptothecin; Colectomy; Female; Fluorodeoxyglucose F18; Fluorouracil; Humans; Leucovorin; Liver Neoplasms; Middle Aged; Positron-Emission Tomography; Radiopharmaceuticals; Radiotherapy; Rectal Neoplasms; Thyroid Neoplasms; Thyroidectomy; Treatment Outcome

Thyroid gland is an uncommon site for involvement by lymphoma. Because of the lack of specific histopathologic criteria for diagnosis, thyroid lymphomas are not usually diagnosed until a thyroidectomy is done, even when a fine-needle aspiration biopsy is performed before surgery. We report the case of a woman with a non-Hodgkin lymphoma presenting as thyroid enlargement with systemic manifestations of the disease. The preoperative histologic diagnosis was poorly differentiated thyroid carcinoma. If the lymphoma was primarily thyroid or the involvement of thyroid was a part of the generalized dissemination of a nodal non-Hodgkin lymphoma is difficult to establish. She was treated with a combination of surgery and chemotherapy with excellent outcome. We comment the problems in the diagnosis of this disease.

Topics: Antineoplastic Combined Chemotherapy Protocols; Biopsy, Needle; Bleomycin; Combined Modality Therapy; Cyclophosphamide; Doxorubicin; Female; Humans; Leucovorin; Lymphoma, Non-Hodgkin; Methotrexate; Middle Aged; Postoperative Care; Prednisone; Thyroid Gland; Thyroid Neoplasms; Thyroidectomy; Vincristine