Sustained Stable Disease with Capecitabine plus Bevacizumab in Metastatic Appendiceal Adenocarcinoma: A Case Report.

In a patient who had been diagnosed in 2006 with appendiceal adenocarcinoma with peritoneal metastases after an incomplete surgery, palliative chemotherapy was administered. First-line treatment with 5-fluorouracil, leucovorin and oxaliplatin (FOLFOX) and second-line treatment including 5-fluorouracil, leucovorin and irinotecan (FOLFIRI) plus panitumumab showed inefficiency in controlling disease progression. Third-line chemotherapy combining capecitabine plus bevacizumab was started, achieving good control of the tumour growth and a minor response in the second computed tomography scan. We decided to maintain the treatment, although forced bevacizumab "breaks" were necessary due to unexpected adverse events, with the patient suffering disease progression every time bevacizumab was stopped and reaching minor response again once the antiangiogenic treatment was reintroduced. During more than 10 years after starting third-line treatment, the patient maintained good performance status and disease stability with this "up and down" management until January 2019, when a neurological adverse event during bevacizumab infusion drove us to abandon it definitely

Primary malignant melanoma of the biliary tract: A case report and literature review

BACKGROUND: Primary malignant melanoma of the biliary tract (MBT) is a rare condition whose diagnosis requires excluding a primary origin in another location. This paper reviews the most important characteristics of MBT cases published in the literature and reports a new case. The patient reported here is the first case of primary malignant melanoma of the biliary tract with pulmonary metastasis treated with immunotherapy. This patient remains disease-free 36 mo after the treatment of metastatic lung lesions. CASE SUMMARY: A 51-year-old man was admitted to the gastrointestinal department to study obstructive jaundice of a 1 wk clinical course. Magnetic resonance cholangiopancreatography revealed dilatation of the intrahepatic biliary tract and stenosis of the common hepatic duct. Given the suspicion of biliary tract neoplasia, cholecystectomy and resection of the common hepatic duct were performed with hepatic jejunostomy free of complications. Anatomo-pathological diagnosis was melanoma. After intervention, the patient was referred to the Department of Medical Oncology, where a primary origin was excluded in the skin, mucosa, and eyes. This confirmed diagnosis of primary biliary tract melanoma. Computed tomography was performed 12 mo after the procedure revealed several subcentimetric lung nodules. Wedge resection was performed. After confirming the diagnosis of pulmonary metastasis of primary melanoma of the biliary tract, the patient was started on immunotherapy with nivolumab. Tolerance to treatment was excellent. The patient remains disease-free 36 mo after the treatment of metastatic lung lesions. CONCLUSION: The patient reported here is the first case of primary malignant melanoma of the biliary tract with lung metastases successfully treated with immunotherapy

Neoplasia papilar mucinosa intraductal (NPMI) de conducto pancreático principal.

Intraductal papillary mucinous neoplasm (IPMN) is an epithelial tumor of mucin-producing cells arising in the main pancreatic duct or its branches. Many cases are detected incidentally during the evaluation for other conditions or due to nonspecific symptoms. The early diagnosis of IPMN is important because it is a premalignant lesion with risk of progression to invasive carcinoma. Here we report a case of main-duct IPMN in a 79-year-old woman. We also describe the main problems for the diagnosis of this lesion, as well as the criteria that determine the therapeutic approachLa neoplasia papilar mucinosa intraductal (NPMI) es un tumor epitelial productor de mucina que deriva de células del conducto pancreático principal o de sus ramas. Este tumor puede presentarse clínicamente como un hallazgo casual en estudios de imagen o producir molestias inespecíficas, pero su reconocimiento es importante pues se trata de lesiones premalignas con riesgo de progresión a carcinoma invasivo. Se presenta el caso de una mujer de 78 años con NPMI de rama principal y se refieren los principales problemas que plantea tanto el diagnóstico como los criterios que determinan la actitud terapéutic