A case report of synchronous primary malignancy: Papillary thyroid carcinoma and non-Hodgkin’s lymphoma

Multiple primary malignancies involving papillary thyroid carcinoma and non-Hodgkin’s lymphoma (NHL) is an extremely unusual event. Here, we report the case of a 70-year-old man presented with high-grade fevers and abdominal discomfort and were found to have pancytopenia. He had generalized lymphadenopathy, hepatosplenomegaly, goiter, and tracheal shift. Biopsy of the left cervical lymph node was positive for papillary carcinoma of the thyroid. He underwent excision biopsy of axillary lymph node which was suggestive of high-grade NHL. The patient was started on chemotherapy (R-CHOP) and his fevers resolved promptly. He then underwent total thyroidectomy and the histopathology of the thyroid gland post-operative showed papillary carcinoma. The second primary malignancy is a second malignant neoplasm occurring in a patient with known cancer. This case highlights the unusual synchronous occurrence of the papillary carcinoma of thyroid and NHL and the diagnostic challenges involved in such cases

A retrospective study on pemetrexed induced nephrotoxicity in non-small cell lung carcinoma patients

Background: Pemetrexed (PEM) is a new-generation multitargeted antifolate agent that has been shown to have broad-spectrum efficacy in a variety of human cancers, including NSCLC and mesothelioma. Dose-limiting hematologic toxicities are among the most serious side effects. PEM nephrotoxicity is well-known, but its occurrence is thought to be rare. Aim was to determine nephrotoxicity induced due to pemetrexed in non-small cell lung cancer patients.Methods: In patients with the NSCLC, we record a retrospective review on PEM- induced renal toxicity. A total of 327 NSCLC patients were treated in our hospital between 2012 and 2019. Of these, 134 patients were diagnosed with 2 or more chemotherapy cycles. 60 of these patients have been diagnosed with combination of antineoplastic drugs based on pemetrexed and platinum. Others were removed from the study and were also required to be tested for other potential causes of renal injury.Results: Suitable statistical tools were used and data was analysed which showed that repeated chemo cycles of pemetrexed leads to the reversible acute kidney injury. With the results from our study we can understand the severity of nephrotoxicity induced with pemetrexed in patients with non-small cell lung cancer. Most of the patients were in the first and second stages of nephrotoxicity and most of them were male. Majority of the patients were also above 40 years of age and also endured more than 4 chemo cycles.Conclusions: It shows that PEM allows longer survival, but acute or chronic kidney failure is the price for this achievement. In conclusion, renal toxicity should be controlled routinely in patients treated with pemetrexed. Before each cycle of pemetrexed, creatinine clearance should be measured. Patients need to be well hydrated during treatment. The patient should also be tested for concomitant medications, and any nephrotoxic symptoms should be reviewed and those drugs removed