Radiation induced esophageal adenocarcinoma in a woman previously treated for breast cancer and renal cell carcinoma

BACKGROUND: Secondary radiation-induced cancers are rare but well-documented as long-term side effects of radiation in large populations of breast cancer survivors. Multiple neoplasms are rare. We report a case of esophageal adenocarcinoma in a patient treated previously for breast cancer and clear cell carcinoma of the kidney. CASE PRESENTATION: A 56 year-old non smoking woman, with no alcohol intake and no familial history of cancer; followed in the National Institute of Oncology of Rabat Morocco since 1999 for breast carcinoma, presented on consultation on January 2011 with dysphagia. Breast cancer was treated with modified radical mastectomy, 6 courses of chemotherapy based on CMF regimen and radiotherapy to breast, inner mammary chain and to pelvis as castration. Less than a year later, a renal right mass was discovered incidentally. Enlarged nephrectomy realized and showed renal cell carcinoma. A local and metastatic breast cancer recurrence occurred in 2007. Patient had 2 lines of chemotherapy and 2 lines of hormonotherapy with Letrozole and Tamoxifen assuring a stable disease. On January 2011, the patient presented dysphagia. Oesogastric endoscopy showed middle esophagus stenosing mass. Biopsy revealed adenocarcinoma. No evidence of metastasis was noticed on computed tomography and breast disease was controlled. Palliative brachytherapy to esophagus was delivered. Patient presented dysphagia due to progressive disease 4 months later. Jejunostomy was proposed but the patient refused any treatment. She died on July 2011. CONCLUSION: We present here a multiple neoplasm in a patient with no known family history of cancers. Esophageal carcinoma is most likely induced by radiation. However the presence of a third malignancy suggests the presence of genetic disorders

Cryptococcose digestive. A propos d’un cas.

La Cryptococcose est une infection grave due à une levure encapsulée type Cryptococcus Neoformans. C’est une infection opportuniste qui survient le plus souvent chez les patients immunodéprimés essentiellement atteint du SIDA. La localisation digestive est rare. Nous rapportons un cas rare de Cryptococcose colique isolée. Patient âgé de 20 ans hospitalisé en mars 2006 au service de chirurgie pour traitement chirurgical d’une poussée sévère de maladie inflammatoire colique de l’intestin étiquetée comme maladie de Crohn à localisation colique et iléale associée à un retard staturo-pondéral depuis l’âge de 15 ans. Traité initialement par corticothérapie puis immunosuppresseurs pendant 2 ans avec une bonne amélioration clinique. Devant une rectorragie massive une colectomie subtotale a été réalisée en urgence. L’examen histologique de la pièce opératoire a retrouvé une Cryptococcose colique avec une polypose de Peutz-Jeghers. Le bilan réalisé à la recherche d’une Cryptococcose disséminée était négatif, ainsi que la sérologie HIV. Le malade a bien évolué sous traitement antifongique La Cryptococcose est une infection opportuniste grave qui survient le plus souvent sur un terrain de déficit immunitaire notamment au cours de l’HIV. La localisation méningée est la plus fréquente. La localisation digestive est rare et s’observe généralement dans le cadre d’une Cryptococcose disséminée. Les particularités de notre observation sont : la localisation primitive et isolée colique évoquant l’éventualité de la porte d’entrée digestive, la survenue en dehors de l’infection par l’HIV montrant l’intérêt de rechercher la Cryptococcose devant toute symptomatologie digestive chez tout sujet immunodéprimé, et l’association avec le syndrome de Peutz Jeghers qui semble être fortuite. Nous rapportons un cas rare de Cryptococcose colique isolée non disséminée chez un patient sous corticoïdes et immunosuppresseurs montrant la possibilité de survenue de cette infection en dehors du HIV

Radiation induced esophageal adenocarcinoma in a woman previously treated for breast cancer and renal cell carcinoma

Abstract Background Secondary radiation-induced cancers are rare but well-documented as long-term side effects of radiation in large populations of breast cancer survivors. Multiple neoplasms are rare. We report a case of esophageal adenocarcinoma in a patient treated previously for breast cancer and clear cell carcinoma of the kidney. Case presentation A 56 year-old non smoking woman, with no alcohol intake and no familial history of cancer; followed in the National Institute of Oncology of Rabat Morocco since 1999 for breast carcinoma, presented on consultation on January 2011 with dysphagia. Breast cancer was treated with modified radical mastectomy, 6 courses of chemotherapy based on CMF regimen and radiotherapy to breast, inner mammary chain and to pelvis as castration. Less than a year later, a renal right mass was discovered incidentally. Enlarged nephrectomy realized and showed renal cell carcinoma. A local and metastatic breast cancer recurrence occurred in 2007. Patient had 2 lines of chemotherapy and 2 lines of hormonotherapy with Letrozole and Tamoxifen assuring a stable disease. On January 2011, the patient presented dysphagia. Oesogastric endoscopy showed middle esophagus stenosing mass. Biopsy revealed adenocarcinoma. No evidence of metastasis was noticed on computed tomography and breast disease was controlled. Palliative brachytherapy to esophagus was delivered. Patient presented dysphagia due to progressive disease 4 months later. Jejunostomy was proposed but the patient refused any treatment. She died on July 2011. Conclusion We present here a multiple neoplasm in a patient with no known family history of cancers. Esophageal carcinoma is most likely induced by radiation. However the presence of a third malignancy suggests the presence of genetic disorders.</p