Case Report: A Case of Sintilimab-Induced Cystitis/Ureteritis and Review of Sintilimab-Related Adverse Events

Immune checkpoint inhibitors (ICIs) have been proven to be beneficial in multiple advanced malignancies. However, the widespread use of ICIs also occurred with various immune-related adverse events (irAEs). Here, we first report a case of sintilimab-related cystitis/ureteritis. A 53-year-old man with driver gene-negative pulmonary adenocarcinoma (cT1cN3M1c, Stage IVB) was being treated with sintilimab in combination of paclitaxel-albumin and bevacizumab as second-line treatment. He was hospitalized for haematuria, pollakiuria, painful micturition and low back pain after three courses. Urinalysis showed red blood cells (RBCs) and white blood cells (WBCs) were obviously increased, and serum creatinine (sCr) level was also significantly elevated. Urine culture and cytology were both negative, and cystoscopy revealed diffused redness of bladder mucosa. Urinary ultrasonography showed mild hydronephrosis and dilated ureter. The patient was diagnosed as immunotherapy-related cystitis/ureteritis after a multidisciplinary team (MDT) meeting. Once the diagnosis was made, corticosteroid therapy was given, which rapidly resolved the patient’s symptoms and signs. Computer tomography angiography (CTA) and CT urography (CTU) was conducted after sCr level was back to normal and demonstrated ureter dilation and hydroureter. Once symptoms relieved, bladder biopsy was performed and confirmed the bladder inflammation. The patient was subsequently switched to maintenance dose of methylprednisolone and tapered gradually. Since sintilimab has been used in advanced malignancies, we first reported a rare case of sintilimab-induced cystitis/ureteritis and summarized sintilimab-related adverse events to improve the assessment and management of irAEs.

So-Called Serous Carcinoma of the Uterine Cervix with BRCA2 Mutation: Case Report and Review of the Literature

Serous carcinoma of the uterine cervix (SCUC) is now believed to be a morphological variant of an HPV-associated endocervical adenocarcinoma or a metastasis from a serous carcinoma of the upper tract. In terms of mutational status as detected by next-generation sequencing (NGS), this controversial entity has not been characterized yet. We describe the case of a patient with a carcinoma categorized as stage IVB SCUC, initially treated with carboplatin, paclitaxel, and bevacizumab, followed by maintenance with bevacizumab. After locoregional progression, radiotherapy was administered. Unfortunately, further progression was observed, and carboplatin was resumed. Considering the presence of a <i>BRCA2</i> mutation as detected by NGS, treatment with a PARP inhibitor (olaparib) was decided and allowed disease control for 6 months. We believe that <i>BRCA</i> mutation may be systematically searched in patients suffering from carcinomas formerly referred to as SCUC and that targeted treatments should be considered.

Hypoalbuminemia for the Prediction of Survival in Patients with Organ Metastatic Cervical Cancer

We evaluated the prognostic significance of malnutrition in patients with metastatic cervical cancer. In this study, we retrospectively analyzed the cases of 43 patients with stage IVB (FIGO2018) cervical cancer treated at our institute during December 2004–December 2017. We determined the correlation between clinicopathological characteristics and survival by performing univariate and multivariate analyses. The serum albumin value at diagnosis was used as an index of malnutrition. The median follow-up period was 16.4 months (range, 0.9—91.4 months). On Kaplan-Meier analysis, the 1- and 2-year overall survival (OS) rates for all patients were 61.6% and 48.6%, respectively. The optimal serum albumin for predicting 1-year survival was 3.3 g/dL, as determined by the receiver operating characteristic curve to maximize the area under the curve. The overall survival (OS) of the patients with albumin >3.3 g/dL (n=28) was significantly better than that of the patients with albumin ≤3.3 g/dL (n=15) (p=0.0041). The multivariate analysis revealed that albumin and mode of primary treatment were significantly associated with survival in patients with stage IVB cervical cancer. Hypoalbuminemia was an unfavorable prognostic factor for patients with metastatic cervical cancer..

Abstract 1122‐000193: Intracranial Bleeding in a Juvenile Nasopharyngeal Angiofibroma Stage IVb

Introduction : The trigeminocardiac reflex has been reported in craniofacial, neurosurgery, ophthalmological surgeries, and recently at endovascular procedures. Therefore, it has been called by other names also as trigeminal depressor reflex, reflex vagal trigeminal, or oculocardiac reflex. It is provoked by the stimulation of branches of the trigeminal nerve and presents cardiovascular alterations such as hypotension, bradycardia, cardiac arrhythmias, which can lead to asystole. This reflex originates at the brainstem and occurs as a rare autonomic dysfunction triggered by the stimulation of baroreceptors. Some factors predispose the appearance of this type of reflex, such as hypercapnia, hypoxemia, superficial anesthetic depth, and acidosis, among others. During these procedures is recommended continuous monitoring of the ECG and PAM. It is always essential to know the patient and modify the risk factors, or even stop the stimulus notifying the surgeon, if there is no adequate response, anticholinergic therapy, such as atropine, and the use of vasopressors should be applied. Methods : We report a clinical case of an 18‐year‐old male with a history of 3 years of recurrent epistaxis diagnosed with a Juvenilenasopharyngeal angiofibroma stage IVB, who underwent diagnostic cerebral angiography for surgical planning. Results : Angiography was performed under conscious sedation. When we placed the JB2 diagnostic catheter in the external carotid artery, the patient presented bradycardia of 40bpm. The catheter was removed, and the heart rate improved; we made a second attempt again with bradycardia, for which atropine was administered, and continued with the procedure without incident. We evaluated the vascular supply to the tumor and ruled out the involvement of the ipsilateral internal carotid artery. An occlusion test was also performed, which was positive. No aneurysms were found during angiography. At the end of the angiography, the patient presented anisocoria and left hemiparesis, so due to the suspicion of a thromboembolic event, a new femoral approach was performed to assess the intracranial circulation we found adequate patency. A non‐contrast head CT was performed, a subarachnoid hemorrhage in the prepontine and the interpeduncular cistern was observed. Medications used for sedation were discontinued to assess his neurological status at that time with GCS of 12. 48 hrs later, the patient was neurologically intact and without sequelae. In the literature review, we did not find reports of intracranial hemorrhage as complications in nasopharyngeal angiofibroma with intracranial extension or secondary to the presentation of the trigeminocardiac reflex. However, we suspected that it could result from a transient elevation of arterial hypertension due to the administration of anticholinergic therapy. Conclusions : Neuroanesthesiologists and endovascular surgeons must be aware of its manifestations and management to avoid complications due to the presentation of this reflex.

Multidetector computed tomography imaging of squamous cell carcinoma of buccal mucosa

<p>This study aims at describing the role of multidetector computed tomography (MDCT) and CT imaging findings in evaluation of squamous cell carcinoma of buccal mucosa and its staging. Retrospective study of 40 patients who underwent MDCT and were histopathogically proven case of squamous cell carcinoma (SCC) of buccal mucosa patients were included in the study. Plain, arterial, venous phase and puff cheek CT cuts were taken from base of skull till clavicle. The imaging findings in squamous cell carcinoma (SCC) of the oral cavity allow the radiologist to accurately determine the extent and staging of disease thereby help clinicians plan appropriate treatment. 40 such patients were done in which majority of them are male patients-27 as compared to female patients-13. Among these 40 patients, 20 patients had stage IVB cancer, 13 patients had stage IVA, 5 patients had stage II and 2 patients had stage I cancer. No patient included in our study had stage III. Patients’ recovery will depend on how early the cancer is found and staging gives an idea of patients’ possible outcomes. MDCT is non-invasive and cost-effective investigation which helps in evaluating squamous cell carcinoma of buccal mucosa and determines its stage of buccal cancer and guide the therapy accordingly.</p>

Squamous Cell Metastasis of Cancer from Cervix to Breast: A Case Report

Squamous cell metastasis from cervical cancer to breast is an extremely rare entity, approximately 29 cases have been documented worldwide since 1947 and it is the second documented case in Ecuador, the incidence is very low, it represents only 1,2 of all malignant neoplasms of the breast, which limits the expertise in the diagnosis and treatment of this metastasis, with the outermost quadrant of the breasts being the most frequent site of presentation. We present the clinical case of a 46-year-old married woman with a history of stage IVB squamous cell cancer of the cervix, who received chemotherapy, a Paclitaxel/Carboplatin regimen for 6 cycles. There was no good response and we had radiotherapy and brachytherapy treatment. The second line of chemotherapy with monodroga Gemcitab is proposed, the scheme is completed for 8 cycles. There is no favorable response, so a second-line chemotherapy treatment with Ifosfomide is proposed. The same metastases are present in the breast as after imaging and pathology examinations, it is concluded that the patient presents cervical Ca squamous cell metastases (cancer) from the cervix, 6 months after the diagnosis of the deceased patient. Metastasis to the breast from a neoplasm of other organs is very rare, the incidence of which is very low and the prognosis is gloomy. Keywords: metastasis, squamous cells, cancer of the cervix. RESUMEN La metástasis de células escamosas de cáncer de cérvix a mama es una entidad extremadamente rara, se ha documentado a nivel mundial aproximadamente 29 casos desde 1947 y es el segundo caso documentado en el Ecuador, la incidencia es muy baja, representa tan solo el 1,2 de todas las neoplasias malignas de la mama, lo que limita la experticia en el diagnóstico y tratamiento de esta metástasis, siendo el sitio más frecuente de presentación el cuadrante superior externo de las mamas. Se presenta el caso clínico de una paciente de 46 años, casada, con antecedentes de cáncer de cérvix de células escamosas en estadio IVB por lo que recibió tratamiento de quimioterapia, esquema Paclitaxel/Carboplatino por 6 ciclos. No hubo buena respuesta y recibió tratamiento de radioterapia y braquiterapia. Se propone segunda línea de quimioterapia con monodroga Gemcitab, se completa el esquema por 8 ciclos. No existió respuesta favorable por lo que se propone tratamiento de segunda línea de quimioterapia con Ifosfomida. Presenta metástasis en mama la misma que posterior a exámenes de imagen y patología se concluye que la paciente presenta metástasis de células escamosas de Ca (cáncer) de Cérvix a mama, 6 meses posterior al diagnóstico la paciente fallece. La metástasis en la mama de una neoplasia de otros órganos es muy raro cuya incidencia es muy baja y de pronóstico sombrío. Palabras claves: metástasis, células escamosas, cáncer de cérvix.

Evaluation of Surgical Therapy in Advanced Thymic Tumors

A complete resection of thymic tumors is known to be the most important prognostic factor, but it is often difficult to perform, especially in advanced stages. In this study, 73 patients with advanced thymic tumors of UICC stages III and IV who underwent radical resection were examined retrospectively. The primary endpoint was defined as the postoperative resection status. Secondary endpoints included postoperative morbidity, mortality, recurrence/progression-free, and overall survival. In total, 31.5% of patients were assigned to stage IIIa, 9.6% to stage IIIb, 47.9% to stage IVa, and 11% to stage IVb. In stages III a R0 resection was achieved in 53.3% of patients. In stages IV a R0/R1 resection was documented in 76.7% of patients. Surgical revision was necessary in 17.8% of patients. In-hospital mortality was 2.7%. Median recurrence/progression-free interval was 43 months (p = 0.19) with an overall survival of 79 months. The 5-year survival rate was 61.3%, respectively. Median survival after R2 resection was 25 months, significantly shorter than after R0 or R1 resection (115 months; p = 0.004). Advanced thymic tumors can be resected with an acceptable risk of complications and low mortality. In stage III as well as in stage IV the promising survival rates are dependent on the resection-status.

80 THE PROGNOSTIC FACTORS ASSOCIATED WITH LONG-TERM SURVIVAL IN THE PATIENTS WITH SYNCHRONOUS OLIGOMETASTATIC ESOPHAGEAL ADENOCARCINOMA

Patients with gastrointestinal cancer are increasingly being diagnosed with oligometastatic disease due to the development of sensitive imaging. Oligometastases (OLM) represent a clinical and anatomical manifestation of resistant localized cancer and/or metastases. However, oligometastatic disease is complicated by the lack of uniformity due to the heterogeneity of cancer, therefore, differing prognoses. The aim of this study is to identify the factors associated with long-term survival in the patients with synchronous oligometastatic esophageal adenocarcinoma (EAC). Methods Between 2002 and 2016, of 1400 patients with EAC (esophagus and Siewert types I and II) treated at our institute, 233 patients initially diagnosed with stage IVB were enrolled. OLM was defined as only metastasized to one organ and less than 5 metastases. We retrospectively analyzed the association between clinicopathological factors and prognosis, especially focused on the pattern of metastases. Results Eighty-five patients (36.5%) had OLM, and 148 (63.5%) had non-oligometastais (Non-OLM). The patients in OLM had significantly better overall survival (OS) than the patients in Non-OLM (p = 0.0001). Univariate analysis showed pattern of metastases (lymphatic OLM) and treatment method (consolidative local radiotherapy: CLT) were significantly associated with prognosis (p = 0.04 and 0.01). Multivariate analysis revealed that lymph node metastases (cN0-N1), number of metastasis (solitary) and treatment (CLT) were independent predictors for OS of patients with OLM. (p = 0.03, 0.01 and 0.001). In OLM patients, the patients with lymphatic OLM who received CLT had more favorable prognosis (5-years survival rate 25%). Conclusion This study suggests that CLT is one of the promising modalities for oligometastatic patients with EAC, especially the patients with lymphatic OLM.