Thoracic Cancer

A rare case of tumor‐to‐tumor metastasis from thymic carcinoma to an ovarian mature teratoma

AbstractMetastasis from one neoplasm to another is referred to as tumor‐to‐tumor metastasis (TTM). TTM is rarely observed. Here, we present a patient with TTM from a thymic carcinoma to an ovarian mature teratoma. A 25‐year‐old woman, diagnosed with unresectable thymic carcinoma, presented with a cyst with a solid tumor component in her right ovary. Laparoscopic cystectomy of the right ovary revealed that the solid tumor was a distant metastasis of the thymic carcinoma in an ovarian mature teratoma. The possibility of malignant transformation of the ovarian mature teratoma was ruled out, enabling accurate staging of the thymic carcinoma. This case emphasizes the need for clinicians to consider TTM and the importance of pathological confirmation of TTM when investigating potential distant metastases.

Homologous recombination deficiency status predicts response to immunotherapy‐based treatment in non‐small cell lung cancer patients

AbstractBackgroundHomologous recombination deficiency (HRD) is a biomarker that predicts response to ovarian cancer treatment with poly (ADP‐ribose) polymerase (PARP) inhibitors or breast cancer treatment with first‐line platinum‐based chemotherapy. However, there are few studies on the prognosis of lung cancer patients treated with immune checkpoint inhibitor (ICI) therapy using HRD as a biomarker.MethodsWe studied the relationship between HRD status and the effectiveness of first‐line ICI‐based therapy in EGFR/ALK wild‐type metastatic non‐small cell lung cancer patients (NSCLC) patients.ResultsThis study included 22 treatment naïve NSCLC patients. The HRD score ranged from −26.37 to 92.34, with an average of 24.57. Based on analysis of the progression‐free survival (PFS) data from the included NSCLC patients, threshold traversal was carried out. HRD (+) was defined as an HRD score of 31 or higher. Kaplan–Meier PFS survival analysis showed prolonged median PFS (mPFS) in NSCLC patients with HRD (+) versus HRD (−) (N/A vs. 7.0 ms, log‐rank p = 0.029; HR 0.20, 95% CI: 0.04–0.96, likelihood‐ratio p = 0.03). In patients with PD‐L1 TPS ≥50% and HRD score ≥31 (co‐status high), the mPFS was temporarily not reached during the follow‐up period. In patients with PD‐L1 TPS <1% and HRD score <31, the mPFS was 3 ms. Cox regression analysis showed that the hazard ratio of the co‐status was 0.14 (95% CI: 0.04–0.54), which was a good prognostic factor, and the prognostic effect of co‐status was better than that of HRD score alone.ConclusionThe HRD status can be identified as an independent significance in NSCLC patients treated with first‐line ICI‐based therapy.

Prognostic factors and benefit populations of ovarian function suppression in premenopausal HR+/HER2+ early‐stage breast cancer patients who received trastuzumab: Evidence from a real‐world study with long‐term follow‐up

AbstractBackgroundHormone receptor‐positive (HR+)/human epidermal growth factor receptor 2‐positive (HER2+) breast cancer exhibits considerable heterogeneity, and it is of great interest whether patients with premenopausal HR+/HER2+ breast cancer treated with trastuzumab can benefit from ovarian function suppression (OFS) therapy similarly to HR+/HER2‐ breast cancer. Here, we conducted a real‐world study in this population to identify both who would derive substantial benefits from the addition of OFS and clinicopathological factors with potential prognostic value.MethodsMulticenter data from 253 premenopausal patients with HR+/HER2+ early‐stage breast cancer who received trastuzumab from October 2009 to October 2018 were retrospectively included. The Kaplan–Meier method was used for survival analysis, while the log‐rank test was used to compare the survival rates. Univariate and multifactor Cox regression analyses were performed to analyze the independent risk factors affecting invasive disease‐free survival (IDFS).ResultsAfter a median follow‐up of 98.50 months, compared with tamoxifen/toremifene alone, tamoxifen/toremifene/aromatase inhibitors plus OFS demonstrated significant benefits in the overall study population (HR = 0.289, 95% CI: 0.100–0.835, p = 0.022, 8‐year IDFS rate: 90.78% vs. 95.54%), especially in the lymph node‐positive subgroup and age ≤40 years subgroup. Age ≤40 years, histological grade >2, lymph node involvement, PR ≤50%, and tamoxifen alone were independent prognostic factors.ConclusionsFor premenopausal HR+ breast cancer patients, HER2 positivity alone is an indication for the addition of OFS in adjuvant endocrine therapy. Age, histological grade, lymph node status, the expression of PR, and OFS treatment were independent prognostic factors in this population.

Pulmonary metastasis with coexisting pulmonary mucosa‐associated lymphoid tissue (MALT) lymphoma 20 years after endometrioid adenocarcinoma surgery: A case report

AbstractLate pulmonary metastasis from endometrioid adenocarcinoma (EA) is rare, and occurrence after >20 years is extremely rare. Here, we report a case of pulmonary metastasis with coexisting pulmonary mucosa‐associated lymphoid tissue (MALT) lymphoma that occurred 20 years after surgery for EA. A 60‐year‐old Japanese woman had previously undergone surgery for primary EA, and 20 years later presented with an abnormality that was detected on chest radiography. Chest computed tomography (CT) revealed two nodules in the right lower lung lobe, which were suspected to be primary lung cancer. Wedge resection was performed, and the intraoperative pathological diagnosis was that of adenocarcinoma with MALT lymphoma; this prompted additional right lower lobectomy. The final pathological diagnosis was pulmonary metastasis from EA with coexisting MALT lymphoma. This is probably the first report on late pulmonary metastasis coexisting with MALT lymphoma 20 years after surgery for EA. Surgeons should be aware of the possibility of late pulmonary recurrence of EA after more than 20 years and should consider aggressive resection.Key pointsSignificant findings of the studyAlthough extremely rare, pulmonary metastasis can occur more than 20 years after surgery for endometrioid adenocarcinoma. Furthermore, pulmonary metastasis from endometrioid adenocarcinoma may coexist with mucosa‐associated lymphoid tissue lymphoma.What this study addsEndometrioid adenocarcinoma requires long‐term postoperative follow‐up to detect recurrence, even in early‐stage cases. Video‐assisted thoracoscopic surgery (VATS) is useful for resecting pulmonary metastasis from endometrioid adenocarcinoma.

Hyperthermic intrathoracic chemotherapy for the treatment of malignant pleural effusion caused by breast and ovarian cancer: A systematic literature review and pooled analysis

AbstractObjectivesBreast and ovarian cancer account for over 30% of malignant pleural effusions (MPEs). Treatment of the metastatic disease requires control of the MPE. Even though primarily symptomatic, the treatment of the MPE can potentially affect the oncological course of the disease. The aim of this review is to analyze the effectiveness of intrathoracic chemotherapy in the treatment of MPE caused by breast and ovarian cancer.MethodsA systematic literature research was conducted up until May 2021. Studies published in English on patients undergoing either surgical or interventional intrapleural chemotherapy were included.ResultsThirteen studies with a total of 497 patients were included. Analysis was performed on 169 patients with MPE due to breast cancer and eight patients with MPE secondary to ovarian cancer. The pooled success rates of intrathoracic chemotherapy for controlling the MPE were 59.1% and 87.5%, respectively. A survival analysis was not possible with the available data. The overall toxicity of the treatment was low.ConclusionsIntrathoracic chemotherapy achieves symptomatic control of the MPE in 59.1% of patients with metastatic breast cancer and 87.5% of patients with metastatic ovarian cancer. This is inferior to other forms of surgical pleurodesis. Data from small case series and studies on intraperitoneal chemotherapy show promising results. However, formal oncological studies on the use of intrathoracic chemotherapy for metastatic breast or ovarian cancer are lacking. Further prospective pilot studies are needed to assess the therapeutic oncological effects of this treatment.

Epithelial granuloma occurring on the staple‐stump after segmentectomy for ovarian cancer lung metastasis

AbstractWhen a mass occurs at the staple line following lung resection, it can be difficult to distinguish between local cancer recurrence and granuloma. We present a case of a staple‐line granuloma with 18F‐fluorodeoxyglucose‐positron emission tomography uptake and elevated serum carbohydrate antigen 19–9 (CA19‐9) in a patient with ovarian cancer lung metastasis. After granuloma resection, serum CA19‐9 levels normalized, and CA19‐9 positive cells were identified in the resected tumor. Therefore, serum CA19‐9 elevation does not rule out a staple‐line granuloma. Whereas granulomas on computed tomography (CT) scans tend to show smooth shadows along the staple line unilaterally, detailed CT evaluation may help diagnostic differentiation. Differentiation based on imaging and tumor markers has limitations. However, core needle biopsy has the risk of misdiagnosis and tumor cell dissemination, therefore surgical resection should be considered when comprehensive findings indicate a potential recurrence.

Detection of human papillomavirus distinguishes second primary tumors from lung metastases in patients with squamous cell carcinoma of the cervix

AbstractBackgroundIn patients with squamous cell carcinoma of the cervix (SCCC), a squamous cell carcinoma (SqCC) in the lung represents either a second primary tumor or metastasis. This distinction between second primary tumors and lung metastases in patients with SCCC significantly influences patient prognosis and therapy. Here, we aimed to differentiate second primary tumors from lung metastases in patients with SCCC by exploring the HPV status in SqCCs involving the lung within a large cohort.MethodsP16 expression was assessed using immunohistochemistry on tissue microarrays including a total of 415 primary lung SqCCs and 21 lung SqCCs with prior SCCC. Following this, we performed HPV DNA typing and the sensitive RNAscope in situ method to screen all the cases for HPV E6/E7 expression, which is a more reliable indicator of transcriptively active HPV in tumor cells.ResultsThe p16 positive expression rate was 13.7% (57/415) in primary lung SqCCs, but HPV DNA was not detected in any of the 57 primary lung SqCC cases that positively expressed p16. In contrast, HPV DNA was detected in all cases (21/21) with prior SCCC. Consistently, all 21 lung SqCCs with prior SCCC (21/21) showed extensive HPV16 E6/E7 expression. In striking contrast, none of the primary lung SqCCs (0/415) had a detectable RNAscope signal.ConclusionsHPV does not seem to play a role in the development of primary lung SqCCs. HPV detection may be helpful in distinguishing second primary tumors from lung metastases in patients with SCCC.

Next‐generation sequencing assisted diagnosis of cervical metastasis in EGFR‐mutated lung adenocarcinoma: A case report

AbstractEGFR mutation has been detected in more than half of non‐small cell lung cancer (NSCLC) patients in Asia. Lung cancer is the main cause of malignant tumor‐related death worldwide. Although distant metastases often occurs in patients with advanced NSCLC, uterine cervical metastasis is rare. Here, we report a case of EGFR‐mutated lung adenocarcinoma with cervical metastasis. A 63‐year‐old female with known lung adenocarcinoma was found to have abnormal vaginal bleeding during osimertinib follow‐up visits. Immunohistochemical (IHC) staining and next‐generation sequencing (NGS) of the biopsy sample from the uterine cervical tumor confirmed metastatic dissemination from the primary lung malignancy. NGS assisted the diagnosis of uterine cervical metastasis from the primary lung. This is another major clinical application of NGS in addition to medication guidance and identification of drug resistance mechanisms.