Sanctuary site central nervous system relapse-refractory DLBCL responding to nivolumab and lenalidomide
Irappa V. Madabhavi, Swaroop Revannasiddaiah, Malay S. Sarkar, Mitul G. Modi
In Press, Corrected Proof, Available online 19 April 2019
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Despite improvement in survival in diffuse large B-cell lymphoma (DLBCL) with the introduction of rituximab, central nervous system (CNS) relapse continues to represent a clinical challenge. In diffuse large B-cell lymphoma (DLBCL), the incidence of CNS relapse is only ∼5% in unselected cohorts. Immunotherapy is the treatment that either boosts the patient’s own immune system or uses man-made versions of the normal parts of the immune system to kill lymphoma cells or slow their growth. We are presenting a thirty-eight year old man who, presented with neck nodes, axillary nodes, altered sensorium, abnormal body movements, unconsciousness, weight loss and, fever, with a past history of DLBCL in May 2008, treated with 6 cycles of CHOP and completed in November 2008. After 9 years in April 2018, the patient developed similar symptoms and treated with salvage chemotherapy with R-DHAP which was completed in September 2018. Post-treatment PET-CT showed partial metabolic response and we started external beam radiotherapy to initial bulky disease. After completion of radiotherapy, the patient was very reluctant for any type of therapy and went home. After one month he presented to us with persistent vomiting, abnormal body movements and, altered sensorium. On examination, his Glasgow Coma Scale (GCS) was E2V3M2 and he was admitted in Intensive Care Unit. The patient was managed with mannitol, dexamethasone, antiepileptics, antibiotics and other supportive care medicines. His brain magnetic resonance imaging (MRI) was showing multiple heterogeneously enhancing lesions with surrounding vasogenic oedema and his cerebrospinal fluid analysis was positive for malignant cells. He was managed with triple intrathecal chemotherapy with methotrexate 12 mg, Cytarabine 50 mg, and Hydrocortisone 50 mg along with other supportive care medicines, and after 4–5 days he regained consciousness and he was able to talk and understand verbal commands. In view of improvement in general condition and performance status, we started biweekly triple intra-thecal therapy, and Inj. Nivolumab 3 mg per kg q 2 weekly. From the second cycle, we started Lenalidomide 10 mg once a day for 21 days with 7 days gap along with 2 weekly nivolumab and biweekly triple IT chemotherapy. After one month his CSF analysis was negative for malignant cells. Now he is on regular treatment with weekly IT chemotherapy, 2 weekly nivolumab and 3 weeks on and one week off lenalidomide. After 2 months of treatment, his MRI Brain was showing. At the time of submission of this article, he has completed the fifth cycle of immunotherapy and two cycles of lenalidomide. He was able to manage his daily ADL and able to walk with a stick. The patient tolerated immunotherapy, triple IT therapy and lenalidomide very well without much intolerable side effects. Therefore, we concluded that nivolumab and lenalidomide was well tolerated and exhibited antitumor activity in extensively pretreated patients with relapsed or refractory sanctuary site CNS B- cell lymphomas. Additional studies of Nivolumab and lenalidomide in these diseases are ongoing.
select article Human papillomavirus (HPV) vaccine and HPV-related head and neck cancer: What’s next?
Human papillomavirus (HPV) vaccine and HPV-related head and neck cancer: What’s next?
F. De Felice, A. Polimeni, V. Tombolini
In Press, Corrected Proof, Available online 5 April 2019
select article Oral tongue cancer in a patient with hereditary nonpolyposis colorectal cancer: A case report and review of the literature
Oral tongue cancer in a patient with hereditary nonpolyposis colorectal cancer: A case report and review of the literature
Andrea Ziegler, Eric Thorpe
In Press, Corrected Proof, Available online 15 March 2019
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Hereditary nonpolyposis colorectal cancer (HNPCC) is an autosomal dominant disorder characterized by mutations of mismatch repair genes leading to the early development of multiple malignancies. The most common malignancy is colorectal cancer but there is a strong association with malignancies of the ovary, endometrium, small intestine, stomach, skin, brain, and pancreas. We report a case of a 35-year-old female with a history of known HNPCC who presented with adenocarcinoma of the small intestine as well as a synchronous oral tongue squamous cell carcinoma. The patient underwent a combined oncologic surgery involving a hemiglossectomy, selective neck dissection, and partial small bowel resection. Despite the wide range of malignancies seen in patients with HNPCC, no cases of oral cavity cancer have previously been reported. This represents the first case in the literature of oral cavity cancer in a patient with HNPCC.
select article Prognostic implications of pathologic lymph nodes in HPV-positive oropharyngeal cancers: Clinical validity and strategies for routine clinical practice
Prognostic implications of pathologic lymph nodes in HPV-positive oropharyngeal cancers: Clinical validity and strategies for routine clinical practice
Rama Jayaraj, Chellan Kumarasamy, Madhav Madurantakam Royam, Shanthi Sabarimurugan, Siddhartha Baxi
In Press, Corrected Proof, Available online 9 March 2019
select article Revisiting and revising the definition of oral submucous fibrosis
Revisiting and revising the definition of oral submucous fibrosis
Mohit Sharma, Raghu Radhakrishnan
In Press, Corrected Proof, Available online 8 March 2019
select article Ossified Carcinoma Ex Pleomorphic Adenoma in accessory lobe of parotid gland: Complexity in clinical, imaging and histologic diagnosis and minimally invasive surgery
Ossified Carcinoma Ex Pleomorphic Adenoma in accessory lobe of parotid gland: Complexity in clinical, imaging and histologic diagnosis and minimally invasive surgery
Raffaele Rauso, Giuseppe Colella, Renato Franco, Andrea Ronchi, Fabrizio Chirico
In Press, Corrected Proof, Available online 7 March 2019
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Carcinoma ex pleomorphic adenoma is not common among malignant salivary tumors and an accessory lobe of parotid gland tumor with a carcinoma ex pleomorphic adenoma histology is even rarer. Management of these tumors include a high index of suspicion, good understanding of the anatomy and a meticulous surgical access. The exceptional localization of an ossified Carcinoma ex Pleomorphic Adenoma in the accessory lobe of the parotid gland, never reported to date in the literature, has prompted us to report this case to stress the challenging difficulties related to clinical and histologic diagnosis and to analyze a minimally invasive intraoral approach.