Complete Response to Stage IV Colorectal Adenocarcinoma with Disease-free Survival at 24 Months: Case Report and Overview of the Literature

Over 150,000 new cases of colon cancer were diagnosed in the US in 2019. Stage and age at diagnosis are important prognostic factors for overall survival (OS). For the age group 70-79, the OS for females with poorly differentiated stage IV colon cancer at 1, 2 and 5 years after surgery is 39%, 15%, and 2%, respectively. We present a case of a 77-year-old female with significant cardiac history. She was diagnosed with stage IV colorectal cancer complicated with enteric fistula. Due to her initial performance status and comorbidities, she was not a candidate for surgery or systemic chemotherapy. Nonetheless, and giving her tumor was microsatellite unstable, she was treated with neo-adjuvant immunotherapy. She achieved complete pathological remission with no evidence of disease found upon surgical resection, for which she eventually qualified due to improvement of performance status. Patient is alive and free of disease 24 months after operation

Cushing Syndrome Due to Ectopic Adrenocorticotropic Hormone Secretion by a Pulmonary Carcinoid Tumor in a Patient with Pneumoconiosis

Objective: Sites with a high prevalence of pneumoconiosis are especially challenging to physicians. The presence of pneumoconiotic nodules on chest computed tomography (CT) scans makes it difficult to localize the source of ectopic adrenocorticotropic hormone (ACTH). Because of false-positive results that may occur with the use of fluorine 18-fluorodeoxyglucose positron emission tomography CT (PET/CT) scans, alternative imaging modalities are needed. Methods: Gallium 68-dodecanetetraacetic acid tyrosine-3-octreotate (68Ga-DOTATATE) is a positron emitter-labeled somatostatin analog used with PET/CT. 68Ga-DOTATATE may improve the diagnostic accuracy of localizing ectopic ACTH-secreting carcinoid tumors in patients with pneumoconiosis by reducing false-positive results. Results: We describe a patient with pneumoconiosis and Cushing syndrome due to ectopic ACTH from a pulmonary carcinoid tumor, highlighting challenges in diagnosis and management. Conclusion: Prospective studies comparing fluorine 18-fluorodeoxyglucose PET/CT with 68Ga-DOTATATE PET/CT for diagnosis of bronchial carcinoid tumors in patients with ectopic ACTH and pneumoconiosis are highly needed. We also review the scarce available literature and provide recommendations based on our experience

Angiosarcoma of the Adrenal Gland Treated Using a Multimodal Approach

Angiosarcoma of the adrenal gland is an extremely rare malignancy. We report a case of a 59-year-old female who presented with abdominal pain and profound anemia. A 7 cm enhancing, lipid-poor adrenal mass with calcifications that extended posterior to the vena cava was identified on imaging. Patient underwent right adrenalectomy with retroperitoneal lymph node dissection. Pathology demonstrated angiosarcoma of the adrenal gland. Consolidative treatment included adjuvant radiation and chemotherapy. Patient remains disease free 1.5 years following treatment. Prior reported literature on the diagnosis and management of adrenal angiosarcoma is reviewed

Angiosarcoma of the Adrenal Gland Treated Using a Multimodal Approach.

Angiosarcoma of the adrenal gland is an extremely rare malignancy. We report a case of a 59-year-old female who presented with abdominal pain and profound anemia. A 7 cm enhancing, lipid-poor adrenal mass with calcifications that extended posterior to the vena cava was identified on imaging. Patient underwent right adrenalectomy with retroperitoneal lymph node dissection. Pathology demonstrated angiosarcoma of the adrenal gland. Consolidative treatment included adjuvant radiation and chemotherapy. Patient remains disease free 1.5 years following treatment. Prior reported literature on the diagnosis and management of adrenal angiosarcoma is reviewed