levoleucovorin and Vulvar-Neoplasms

Vulvar metastasis of colorectal cancer (CRC) and acquired resistance to cetuximab is a very rare phenomenon. To our knowledge, few cases have been reported in the English literatures.. A 55-year-old woman was diagnosed as adenocarcinoma of the rectum and the primary tumor was detected to be Kirsten-RAS (KRAS) wild type.. The patient was diagnosed with rectal adenocarcinoma by colonoscopy. Positron emission tomography/computed tomography (PET-CT) revealed multiple lymph node and bone metastases.. The patient received a first-line course of palliative chemotherapy with FOLFOX combined with cetuximab.. After an initial response, acquired resistance to cetuximab occurred and vulvar metastasis was established by a second biopsy. Further molecular analysis showed that the KRAS mutation was detected in plasma samples and tumor tissues.. Vulvar metastasis from CRC is relatively rare and indicates a poor prognosis. Routine physical examinations of cutaneous and subcutaneous may facilitate early detection of metastases and timely intervention of medical technology. Moreover, combining serial tumor biopsy, liquid biopsy, and radiologic imaging could help to define mechanisms of drug resistance and to guide selection of therapeutic strategies.

Topics: Adenocarcinoma; Antineoplastic Agents, Immunological; Antineoplastic Combined Chemotherapy Protocols; Cetuximab; Drug Resistance, Neoplasm; Fatal Outcome; Female; Fluorouracil; Humans; Leucovorin; Middle Aged; Mutation; Organoplatinum Compounds; Proto-Oncogene Proteins p21(ras); Rectal Neoplasms; Vulvar Neoplasms

Topics: Adenocarcinoma; Aged; Anemia; Antifibrinolytic Agents; Antineoplastic Combined Chemotherapy Protocols; Blood Coagulation; Carcinoma, Squamous Cell; Cecal Neoplasms; Disseminated Intravascular Coagulation; Fatal Outcome; Female; Fibrinogen; Fibrinolysis; Fluorouracil; Heart Diseases; Hemorrhage; Humans; Leucovorin; Lung Neoplasms; Lymphatic Metastasis; Multiple Organ Failure; Neoplasms, Multiple Primary; Organoplatinum Compounds; Postoperative Complications; Thrombosis; Tranexamic Acid; Vulvar Neoplasms

Rectovaginal fistula in long-standing Crohn's disease is possibly associated with malignant transformation to mucinous adenocarcinoma of the vagina. However, there have been no previously reported cases documenting vulvar cancer in association with rectovaginal fistula in Crohn's disease. We report 2 cases of vulvar mucinous adenocarcinoma associated with Crohn's disease. Both showed vulvar symptoms after the development of rectovaginal fistula. CASE 1: A 48-year-old woman, with a 30-year history of Crohn's disease including a rectovaginal fistula, developed persistent pyoderma gangrenosum. Further workup revealed metastatic vulvar mucinous adenocarcinoma. CASE 2: A 37-year-old woman with long-standing Crohn's disease including numerous episodes of perianal or rectovaginal fistulas complained of a vulvar mass suspicious for an abscess. Biopsy showed mucinous adenocarcinoma.. Vulvar lesions or symptoms in the setting of rectovaginal fistula in Crohn's disease are an important clinical feature and the possible development of vulvar cancer should be considered.

Topics: Adenocarcinoma, Mucinous; Adult; Antibodies, Monoclonal; Antibodies, Monoclonal, Humanized; Antineoplastic Combined Chemotherapy Protocols; Bevacizumab; Biopsy, Fine-Needle; Crohn Disease; Diagnosis, Differential; Female; Fluorouracil; Humans; Leucovorin; Lung Neoplasms; Middle Aged; Organoplatinum Compounds; Oxaliplatin; Positron-Emission Tomography; Rectovaginal Fistula; Vulvar Neoplasms