Non-Hodgkin Lymphoma Secondary to Cancer Chemotherapy in a Patient with Small Cell Carcinoma of the Pancreas

Increased survival seen in patients with solid cancers achieved through aggressive treatment has transformed the prognosis and the complications of the therapy. The carcinogenic effect of the therapeutical agents has given leads to an increased incidence of second malignancies. This case report describes the rare metachronous association of two malignancies and to discuss the etiological links. A 51-year-old man presented with enlargement of right axilla and mesentery lymph nodes. The patient had a history of small cell carcinoma at the head of the pancreas and was treated with chemotherapy cisplatin and gemcitabine for 12 cycles two years prior. Biopsies were then performed. Diagnosis of Non-Hodgkin Lymphoma (NHL) follicular (nodular) type was decided from microscopic and immunohistochemistry results. We discussed that secondary NHL due to chemotherapy for solid cancer is rare. Testicular cancer, ovarian cancer, and breast cancer are the common primary tumors. The primary tumor from a small cell carcinoma of the pancreas (SCCP) is sporadic. The risk ofsecondary lymphoma increases after the first five years of completion of chemotherapy or radiotherapy and persists for more than three decades. In conclusion, this case reinforces the need for long-term follow-up of all patients exposed to chemotherapy for the treatment of pancreatic cancer. Keywords: Secondary NHL, chemotherapy, small cell carcinoma of the pancrea

Mutational heterogeneity between different regional tumour grades of clear cell renal cell carcinoma

Only a limited number of studies have explored the possible associations between tumour grade and mutated genes in clear cell renal cell carcinoma (ccRCC), and we set out to investigate this further using a multiple sampling and next generation sequencing (NGS) approach in a series of ccRCCs. Multiple regions were sampled from formalin-fixated paraffin-embedded ccRCC tumour blocks from seven patients. In 27 samples from six patients, we performed targeted NGS using a custom 42-gene panel based on the most frequently mutated genes in ccRCC reported in public databases. In four samples from the seventh patient, we performed whole exome sequencing (WES) and array comparative genomic hybridisation for detection of copy number variants (CNVs). Mutated genes and the tumour grades of the samples in which they had been identified were compared both within and between all individual tumours. CNVs were compared across all samples from patient 7. We identified clear genetic heterogeneity within and across tumours, but VHL mutations were seen in all patients. Looking across all samples, we identified eleven genes that were only mutated in samples with one particular tumour grade. However, these genes were never mutated in all samples with that tumour grade. Increasing chromosomal instability corresponded with increasing tumour grade, but we observed minimal association between tumour grade and total mutational load in the WES data. Our study confirms the genetic heterogeneity and tumour grade heterogeneity of ccRCC. Although a relatively small number of samples was analysed, genes were identified that could potentially be specific, though insensitive, markers of higher ccRCC tumour grades