Tislelizumab, a humanized IgG4 monoclonal antibody targeting programmed cell death protein 1 (PD-1), has demonstrated efficacy in advanced malignancies such as non-small cell lung cancer, nasopharyngeal carcinoma, classical Hodgkin lymphoma, and esophageal squamous cell carcinoma. Bullous epidermal necrolysis (BEN) associated with single-agent PD-1 inhibitors is rare and remains poorly characterized. We report three cases to describe their clinical presentation, histopathologic findings, management, and possible pathogenesis. Three men aged 56, 81, and 70 years developed rapidly progressive erythema, flaccid bullae, or sheet-like desquamation involving 25%, 40%, and 30% of the body surface area, respectively, within 2-3 days after tislelizumab infusions for retroperitoneal lymph node adenocarcinoma, stage IV lung cancer, and esophageal squamous cell carcinoma. Skin biopsy in Cases 1 and 2 showed full-thickness epidermal or keratinocyte necrosis with subepidermal clefting; direct immunofluorescence in Case 1 was negative. Tislelizumab was discontinued permanently. All patients received systemic methylprednisolone and intravenous immunoglobulin, together with supportive and topical care as appropriate. Re-epithelialization or marked clinical improvement occurred without rechallenge. Early recognition, immediate drug discontinuation, and immunosuppressive therapy were associated with favorable outcomes. Vigilant assessment and multidisciplinary collaboration are important during immune checkpoint inhibitor therapy. Further studies are needed to define susceptibility factors and optimal targeted interventions.
Benign maxillary sinus lesions, such as fibrous dysplasia, osteoma, ameloblastoma, and dentigerous cysts, are uncommon and may be misinterpreted as chronic rhinosinusitis due to overlapping clinical characteristics. A combination of histopathological evaluation and imaging is essential to achieve an accurate diagnosis and guide appropriate surgical intervention. This case series presents four patients ranging in age from 27 to 41 years, each diagnosed with a distinct benign maxillary sinus lesion. The patients presented with different symptoms including nasal blockage, postnasal drip, and facial discomfort. Radiologic evaluation demonstrated four unique lesion patterns: fibro-osseous growth, calcified masses, cystic changes with ectopic teeth, and solid expansile tumors. Three patients were managed with endoscopic sinus surgery, while one required open resection due to tumor recurrence and bony involvement. Histopathological examination confirmed the diagnoses of bilateral dentigerous cysts, ameloblastoma, fibrous dysplasia, and benign osteoid lesion, respectively. Although uncommon in otorhinolaryngology practice, benign maxillary sinus lesions carry important diagnostic and therapeutic implications. Endoscopic techniques provided effective management in the majority of patients, reducing morbidity while preserving normal anatomical structures. However, open surgery and interdisciplinary planning could be required for locally aggressive tumors, such as maxillary ameloblastomas. Each case highlights the importance of individualized management based on radiographic extent, recurrence risk, and lesion behavior. Despite their rarity, benign maxillary sinus lesions should be considered in individuals with atypical or refractory sinonasal symptoms. Accurate histopathological analysis combined with thorough radiologic evaluation remains necessary. While endoscopic approach is generally successful, open resection should be reserved for complicated or recurrent cases.
According to statistics, airway injuries occur most often as a result of car accidents or blunt force-induced chest trauma. However, in recent years, there has been an increase in the number of reports of medically induced tracheal injuries compared to the previous ones, mostly due to operations such as tracheal intubation and neck surgery. In this article, we report a case of severe tearing of the membranous part of the trachea due to tracheal intubation for total lung lavage in The First Affiliated Hospital of Chengdu Medical College. This was a 52-year-old female patient who was admitted to the hospital, for recurrent cough and sputum for more than 6 months with 3 days of exacerbation. Her diagnosis was silicosis. During the whole lung lavage, the patient suffered from a severe airway laceration. After comprehensive consideration, we decided to abandon surgical and invasive treatment procedures and instead chose a conservative treatment plan. Eventually, the self-repair of the damaged membranous part of the airway was achieved. Most past case reports of tracheal injuries have opted for a surgical approach to treatment. However, after reviewing the development of the treatment plan for this patient, we concluded that a shift from surgical to nonsurgical treatment was feasible.
Inferior vena cava (IVC) filters are widely used to prevent pulmonary embolism in patients with venous thromboembolism. However, failure to remove retrievable filters within the recommended time window leads to significant long-term complications, the incidence of which has been gradually increasing. While filter tilt, adhesion, and venous wall penetration are commonly encountered, rare complications such as duodenal perforation by a filter foot or recovery hook present unique clinical challenges. Conventionally, such cases have necessitated open surgical removal due to the high risk of massive hemorrhage or bowel injury associated with standard endovascular retrieval techniques. Conventional endovascular retrieval is contraindicated for permanent filters or when the recovery hook has penetrated the IVC wall. This case series demonstrates the successful application of a novel endovascular technique in these two extreme scenarios. We describe two patients with IVC filters that had been implanted for 9 and 8 years, respectively, who presented with epigastric pain and were found on gastroscopy to have a filter foot penetrating the duodenal wall. In the first case, a permanent Simon Nitinol filter lacked a recovery hook; in the second, the recovery hook of a Günther Tulip filter had itself pierced the IVC wall, and the filter foot was located in close proximity to the abdominal aorta. Both patients were deemed poor candidates for conventional intervention or refused open surgery. A novel endovascular technique was employed utilizing a combination of balloon-assisted intimal peeling, customized LOOP technology applied to the filter body, and real-time intra-arterial roadmap guidance via a pigtail catheter in the aorta. This novel endovascular technique offers a minimally invasive alternative for complex cases involving permanent filters and IVC-penetrating recovery hooks, with potential applicability in experienced interventional centers, though further validation is required.
Idiopathic granulomatous mastitis (IGM) is a rare, benign, chronic inflammatory breast disease that frequently mimics infection or malignancy, resulting in diagnostic and therapeutic challenges. Although erythema nodosum is a recognized extramammary manifestation, it occurs in approximately 10% of cases and may further obscure timely diagnosis. Our objective is to present a rare case of granulomatous mastitis and highlight the challenges associated with its diagnosis and management. We report the case of a 25-year-old Hispanic female who presented with persistent right breast inflammation unresponsive to multiple courses of antibiotic therapy. Diagnostic evaluation with core needle biopsy confirmed IGM. The patient developed concurrent erythema nodosum, representing a rare clinical presentation. Initial management with high-dose systemic corticosteroids resulted in significant adverse effects and progressive disease. Given refractory symptoms and intolerance to medical therapy, the patient underwent a right total mastectomy. Final surgical pathology confirmed the diagnosis of IGM. This case underscores a rare association between IGM and erythema nodosum and highlights the importance of early tissue diagnosis to guide management. While systemic corticosteroids and immunosuppressive therapy remain the cornerstone of treatment, surgical intervention should be considered in patients with severe, refractory disease or those experiencing significant complications from medical therapy. An individualized, severity-based approach and multidisciplinary management are essential for optimizing outcomes in this uncommon condition.
Sebaceous carcinoma (SC) is a rare malignant tumor originating from skin appendages. Most cases occur in the periocular region, whereas extraocular SC accounts for only about 25% of cases and is especially rare on the scalp. Extraocular SC often presents without characteristic clinical features, frequently leading to misdiagnosis as benign lesions, such as epidermal cysts. Here, we report a 36-year-old male with an atypical presentation of extraocular SC in the occipital region, highlighting its diagnostic challenges and clinical importance. Our patient presented with a slowly enlarging subcutaneous mass in the left occipital region that had persisted for more than 2 months. The mass was non-tender, showed no ulceration, and had not increased rapidly in size, mimicking benign lesions such as an epidermal cyst. There was no family history of malignancies or hereditary dermatological disorders. Color Doppler ultrasonography revealed a hypoechoic scalp nodule measuring approximately 2.3 cm × 2.0 cm × 1.0 cm. The lesion was initially diagnosed as a pilar cyst and surgically excised. Histopathological examination demonstrated a large epithelial-derived tumor characterized by indistinct margins and asymmetry. Immunohistochemical analysis showed androgen receptor (AR; +), P63(+), gross cystic disease fluid protein-15 (GCDFP-15; -), and Ki-67(+, 30%). The diagnosis was confirmed as SC of the left occipital region. Mohs micrographic surgery was recommended; however, the patient was lost to follow-up. This case illustrates that extraocular SC of the scalp can be easily misdiagnosed as a benign cyst owing to its atypical presentation. Imaging alone is insufficient for a definitive diagnosis. Clinicians should remain alert to red flags suggesting malignancy in scalp lesions, including firm consistency, persistent growth, poorly defined margins, and unusual clinical features, regardless of patient age. Early skin biopsy remains the gold standard for accurate and timely diagnosis. This case underscores the importance of recognizing rare extraocular SC to prevent misdiagnosis and delays in treatment.
Langerhans cell sarcoma (LCS) is an extremely rare malignant tumor originating from the neoplastic proliferation of Langerhans cells. To report a rare case of LCS with a prolonged clinical course following surgical excision and chemotherapy, we present this case report. We report the case of a 46-year-old female Han Chinese patient who presented with persistent right calf pain. Surgical excision was performed, and the diagnosis of LCS was confirmed histopathologically and by immunohistochemical evaluation. Postoperative positron emission tomography/computed tomography (PET/CT) performed 24 days after surgery revealed bilateral femoral and tibial lesions, which are consistent with LCS in conjunction with pathological findings. The patient received six cycles of anthracycline chemotherapy. Subsequently, abdominal contrast-enhanced computed tomography (CT) and PET/CT indicated liver dissemination, prompting a switch to six cycles of ifosfamide chemotherapy. Follow-up evaluations demonstrated stable disease. After a treatment-free interval of 23 months, repeat abdominal contrast-enhanced CT showed complete resolution of the liver dissemination. The patient remains in stable condition during regular follow-up, with overall disease duration exceeding 9 years. Given the rarity of LCS, there are no standardized recommendations for adjuvant therapy, including radiotherapy and chemotherapy regimens for both localized and systemic disease. This case suggests that surgical excision followed by chemotherapy may be effective in preventing and controlling recurrence and systemic progression. Further research is needed to establish evidence-based management guidelines for LCS.
Gallbladder perforation caused by the anatomical proximity of a liver abscess or indirect inflammatory erosion occurs in less than 3% of reported cases. This case report describes the clinical course of an 84-year-old male patient who developed sepsis secondary to gallbladder perforation caused by a liver abscess. This report, through a representative case, discusses its diagnostic challenges and management strategies to enhance clinical awareness. The patient presented with a one-day history of right upper quadrant pain and fever. No signs of acute abdominal conditions, such as gastrointestinal perforation, acute pancreatitis, acute cholangitis, or acute appendicitis, were observed on the admission abdominal computed tomography (CT) scan. Within 2 days, the condition progressed with worsening abdominal pain, high fever, and hypotension. An incidental finding on contrast-enhanced ultrasound revealed a liquefied abscess in liver segment V communicating with the gallbladder lumen, confirming the diagnosis of a liver abscess with secondary gallbladder perforation. Blood culture identified Escherichia coli, indicating sepsis progression and diagnostic delay. This course illustrates rapid deterioration from localized infection to systemic life-threatening illness with organ dysfunction. Immediate interventions included ultrasound-guided percutaneous abscess drainage and culture-directed antibiotic optimization, supported by nutritional and symptomatic care. Following treatment, the patient recovered favorably, with imaging showing reduced abscess size, restored gallbladder wall integrity on follow-up ultrasound, and no recurrence on subsequent monitoring. This case unveils a rare yet fatal complication of liver abscess perforating into the gallbladder. It serves as a critical reminder for clinicians to include this entity in the differential diagnosis when a liver abscess is adjacent to the gallbladder and systemic infection worsens. Subtle clues on contrast-enhanced CT or ultrasound, such as focal discontinuity of the gallbladder wall, are key to early identification. A staged approach centered on interventional drainage, supported by a multidisciplinary team, is central to the successful treatment of such critically ill patients.
Nephroblastoma, also known as Wilms tumor, is one of the most common malignancies diagnosed in children. Contrarily, the incidence in adults is only 0.2 cases per million people annually. As such, there are no standardized guidelines for clinical management in adults. This case describes an adult male in his twenties who presented to the emergency department with 1 week of intermittent hematuria and right flank pain. Imaging unexpectedly revealed a large, radiographically abnormal-appearing mass in the upper pole of the right kidney. The decision was made to biopsy the mass to assist with decisions regarding intervention in case neoadjuvant chemotherapy was indicated. This was later pathologically found to be consistent with nephroblastoma (Wilms tumor). The patient underwent adrenal-sparing right radical nephrectomy with regional lymph node dissection followed by adjuvant chemotherapy with vincristine and dactinomycin. Prior to this, he underwent testicular sperm extraction (TESE) due to azoospermia and fertility concerns. He tolerated this well and has had no evidence of disease on surveillance imaging 9 months postoperatively. This case report provides unique insight into specific diagnostic and intraoperative surgical considerations for abnormal adult presentation of nephroblastoma. Specifically, we discuss the role of preoperative biopsy for consideration of neoadjuvant therapy and the role of adrenal-sparing and lymph node sampling. We highlight this in the context of the current literature available regarding the management of adult nephroblastoma.
SMARCA4-deficient undifferentiated lung carcinoma is a rare, highly aggressive tumor with a dismal prognosis and limited response to conventional therapies. This case report presented an exceptional instance of long-term survival exceeding 41 months in a patient with unresectable stage IIIA (T3N1M0) disease, to provide insights into potential therapeutic avenues for this challenging disease. This article reports a case of a 51-year-old male patient diagnosed with SMARCA4-deficient undifferentiated carcinoma in the left upper lung lobe, unresectable stage IIIA (T3N1M0) disease. During the hospitalization, the patient received multimodal therapy combining chemotherapy, immunotherapy, and radiotherapy, followed by immunotherapy maintenance. Specifically, the patient underwent six cycles of induction therapy with the etoposide plus cisplatin regimen combined with sintilimab, followed by intensity-modulated radiation therapy (pGTV 48 Gy, pCTV 48 Gy), and subsequently received maintenance sintilimab monotherapy. Over a follow-up exceeding three years, the primary lesion completely disappeared, another lesion was significantly reduced and remained stable, with no distant metastases (such as brain, bone, or liver metastases) throughout the course, achieving sustained deep remission. As of the latest reexamination in May 2025, the progression-free survival reached 41 months, and the overall survival has not been reached yet. For this highly aggressive SMARCA4-deficient tumor, the sequential treatment strategy of "induction chemotherapy-immunotherapy followed by consolidative radiotherapy" enables long-term disease control, and immunotherapy maintenance also demonstrated significant value in delaying disease progression. The experience from this case could inform the diagnostic and therapeutic approach for this rare subtype of lung cancer.
Congenital knee dislocation (CKD), or genu recurvatum, is an uncommon congenital deformity marked by knee hyperextension and restricted flexion. It may occur either as an isolated finding or in association with other conditions. CKD can be diagnosed prenatally or postnatally. Most of the cases are treated during infancy by manipulation and serial casting or splinting without surgical intervention. This case report aims to enhance the understanding of this condition and its associations, improving the process of early diagnosis and management to prevent long-term functional impairment. We report a case of a full-term female newborn with bilateral passive fixed hyperextension of the knees, limited flexion, and a full range of motion. She was born via lower segment caesarean section (LSCS) to a 28-year-old G3P1A1 (gravida 3, para 1, abortus 1) Emirati patient. The pregnancy was complicated by iron deficiency anemia, frequent micturition, vulvovaginitis, and gestational diabetes mellitus. The patient underwent knee reduction-manipulation and received serial casting and repeated radiographic evaluation for improvement. After 1 year of physiotherapy and serial casting followed by splinting, the patient exhibited an excellent prognosis and is walking normally with no pain or progressive deformity; however, a small degree of hyperextension remains. Early recognition is crucial to enable prompt treatment and improve the likelihood of a favorable outcome. Management should be tailored to the condition of the joint and any associated abnormalities.
Desmoid type fibromatosis (DTF) is a rare, non-metastasizing but locally invasive intermediate soft tissue tumor. With an annual incidence of 2-4 per million, it is particularly rare during pregnancy. The particularity of this case is that the patient is pregnant, 14 weeks gestation, placenta previa, and a large mass is found in the abdominal pelvic cavity. The patient requests to terminate the pregnancy and remove the abdominal pelvic cavity mass. The large mass originates from ileocecal area, which is extremely rare and can be an excellent supplement to the literature. A 32-year-old woman found out she was pregnant 6 weeks after her last period and had no discomfort. At 14 weeks of pregnancy, ultrasound and magnetic resonance imaging (MRI) showed: there was a huge hypoechoic mass above the uterus, accompanied by connecting blood vessels. It was misdiagnosed as uterine fibroids. Through multidisciplinary team (MDT) assessment, formulated a surgical plan. The patient and her family signed the informed consent form and decided to undergo the surgery. Following termination of pregnancy, exploratory laparotomy uncovered a mass originating from the ileocecal region, with vascular connections to the uterine surface but no significant adhesions. The patient underwent successful tumor resection with ileocecal resection. Histopathological examination of the mass confirmed a diagnosis of DTF, characterized by spindle cells without significant atypia. Immunohistochemistry was pivotal, showing nuclear positivity for β-catenin and a Ki-67 index of <10%, while being negative for markers like CD117, effectively ruling out gastrointestinal stromal tumor (GIST). Through this case, we recognize that there is a vascular connection between the tumor and the uterus, and its origin is not necessarily the uterus; it could be of intestinal origin. The uniqueness of this case lies in: a huge mass was found in the pregnant woman's abdominal and pelvic cavity, without intestinal obstruction, and there is a vascular connection with the uterus. This case underscores the diagnostic difficulty of DTF. A clear diagnosis depends on postoperative pathological examination and immunohistochemistry, and multidisciplinary collaboration is of vital importance.
Pulmonary mucoepidermoid carcinoma (PMEC) accounts for less than 1% of pulmonary malignancies and is predominantly primary, exhibiting distinct clinical manifestations and treatment responses compared to lung adenocarcinoma (LUAD). Although the incidence of histological transformation from non-small cell lung cancer (NSCLC) to small cell lung cancer (SCLC) following tyrosine kinase inhibitor (TKI) therapy is approximately 3-14%, transformation from LUAD to PMEC is an extremely rare event. Currently, there is a lack of unified understanding and diagnostic/therapeutic guidelines concerning its mechanism, clinical features, treatment strategies, and prognosis. This article reports a case of HT from LUAD to PMEC following anaplastic lymphoma kinase (ALK)-TKI therapy, aiming to enhance clinicians' awareness of this rare condition and provide preliminary reference for the diagnosis and management of similar cases. This report describes a 45-year-old female patient who was admitted to the hospital with a chief complaint of "persistent cough, sputum production, and dyspnea for 2 years, accompanied by chest tightness for 1 week". She was diagnosed with ALK exon 20 mutation-positive left LUAD (cT1N1M1, stage IV). After 28 months of first-line ALK-TKI alectinib therapy, the patient experienced disease progression. Repeated pathological biopsy confirmed a transition from LUAD to PMEC, with persistent ALK mutation. Subsequent treatment included lorlatinib and third-line chemotherapy (pemetrexed/carboplatin regimen for four cycles), achieving acceptable disease control. The progression-free survival (PFS1) prior to transformation was 8 months, and the patient is currently receiving palliative care. Tumors that undergo LUAD-to-PMEC transformation after ALK-TKI therapy exhibit persistently low levels of ALK fusion and characteristic immunohistochemical alterations [deletion of thyroid transcription factor-1 (TTF-1)/Napsin A, upregulated expression of CK5/6/P40], along with inherent resistance to ALK-TKIs. When heterogeneous resistance emerges during TKI therapy, prompt repeat biopsy with concurrent pathological and next-generation sequencing (NGS) testing is recommended. If confirmed, immediate transition to phenotype-specific therapy should be initiated. Although this is a single-case observation requiring validation in larger cohorts, these findings provide preliminary guidance for clinical identification and management of such rare transformations.
Hepatocellular carcinoma (HCC) with tumor thrombus extending into the inferior vena cava (IVC) represents an advanced stage of disease and is associated with a poor prognosis. Surgical resection combined with thrombectomy remains a potentially curative option but carries substantial perioperative risk. Intraoperative transesophageal echocardiography (TEE) provides real-time imaging that may improve procedural safety and surgical precision. We report the case of a 49-year-old woman with advanced HCC complicated by tumor thrombus extending from the left portal vein and left hepatic vein into the IVC, with intermittent prolapse toward the right atrium. Preoperative assessment showed Child-Pugh class A liver function (score 6), an Eastern Cooperative Oncology Group (ECOG) performance status of 2, chronic hepatitis B infection without prior antiviral therapy, and preserved coagulation function. Imaging demonstrated cirrhosis and splenomegaly. The patient underwent left hemihepatectomy with IVC tumor thrombectomy under continuous intraoperative TEE guidance. TEE enabled dynamic assessment of thrombus mobility, guided repositioning of the thrombus from the right atrium into the IVC, informed the clamping strategy, and allowed immediate detection of acute bland thrombus formation after vascular repair. Prompt re-intervention was undertaken, and IVC patency was successfully restored. Histopathology confirmed moderately to poorly differentiated HCC with vascular invasion and tumor thrombus [pT4N0M0, American Joint Committee on Cancer (AJCC) 8th edition]. Postoperatively, the patient developed intrahepatic recurrence and received transcatheter arterial chemoembolization (TACE) and targeted therapy. At 12-month follow-up, no recurrence of IVC tumor thrombus was detected. This case highlights the value of anesthesiologist-led intraoperative TEE in complex oncovascular surgery. Continuous TEE guidance facilitated key vascular maneuvers, supported real-time intraoperative decision-making, and enabled early recognition of a potentially life-threatening complication. TEE should be considered an important intraoperative navigation tool in high-risk HCC thrombectomy.
Large, non-pancreatic pseudocysts are rare pathologies that present as lesions in the intra-abdominal wall or peritoneal cavity. These cases can be diagnostically difficult, particularly in situations where fine-needle aspiration yields nonspecific cytology and imaging is also often nonspecific and nondiagnostic. These lesions may mimic hematomas, seromas, cystic neoplasms, and other bowel-related pathologies, which may require surgical excision for definitive diagnosis and curative treatment. We present a case of a 73-year-old male with a body mass index of 43 who presented to the emergency department for a ureteral stone and was found on computed tomography (CT) imaging incidentally to have a large left lower quadrant abdominal wall mass. The lesion was highly vascularized and intimately adherent to both the abdominal wall and colon. Two separate biopsy results showed nonspecific cytology and hemorrhagic debris. Operative excision required tedious removal from the bowel and abdominal wall and evacuation of 3 L of fluid. Pathology results showed a chronic pseudocyst lacking an epithelial lining. The case demonstrates the diagnostic limitations of fine-needle aspiration and imaging, along with the potential for abdominal pseudocysts to mimic multiple differentials. Additionally, it highlights the importance of complete surgical excision for diagnostic and curative treatment.
Apert syndrome is a rare congenital malformation caused by a mutation in the fibroblast growth factor receptor 2 (FGFR2) gene. Characteristic imaging findings include bilateral premature closure of the coronal suture, midfacial hypoplasia, and symmetrical syndactyly of the fingers and toes. These features may be accompanied by lateral ventricle dilation, absence of the corpus callosum, cervical vertebral fusion, and other anomalies. However, in the second trimester, syndactyly and extracranial anomalies may be the only detectable signs, which complicate early diagnosis. The purpose of this study is to improve the early diagnosis rate of Apert syndrome. We report an atypical case of Apert syndrome carrying the FGFR2 S252W mutation, which typically associated with severe cranial deformities and cleft palate, but prenatal ultrasound at 23 weeks revealed symmetrical syndactyly of both hands and feet and a sacrococcygeal soft tissue mass resembling a "tail" without cranial abnormalities. Although prior studies have linked this mutation to advanced paternal age, the father in this case was 25 years old, which does not align with this association. This case demonstrated that Apert syndrome may present prenatally features other than cranial abnormalities. A practical screening strategy should therefore combine detailed second-trimester ultrasound evaluation of extremities and cardiac structures with prenatal genetic testing, even in the absence of cranial abnormalities.
Complete lung atelectasis resulting from main bronchial obstruction may arise from both benign and malignant etiologies. Diagnosis is often delayed, particularly in younger patients, leading to prolonged lung collapse and compensatory hemidiaphragmatic elevation. Pneumonectomy is traditionally considered in such cases, lung-sparing resections should be preferred, especially in young individuals. The indication for sleeve resection in the setting of long-standing complete atelectasis remains controversial. We report the clinical presentation, surgical management, and outcomes of two patients with chronic dyspnea and presented with long-standing complete right lung atelectasis secondary to right main bronchus obstruction, treated with lung parenchyma-sparing procedures. A 30-year-old woman with post-tuberculosis bronchial stenosis (treated in 2018 at the Institute of Pneumonology "Marius Nasta", Bucharest) and a 34-year-old man with a typic endobronchial carcinoid tumor (treated in 2025 at the Centre Hospitalier Monkole, Kinshasa) were included. Both patients underwent right upper sleeve lobectomy by lateral thoracotomy. They were discharged on day 6, with an uneventful short- and long-term outcomes, including rapid improvement of pulmonary function. Even in cases of prolonged complete lung atelectasis due to main bronchial obstruction, lung-sparing resection is feasible and effective. It avoids pneumonectomy and is not associated with increased perioperative or long-term complications.
SMARCA4-deficient lung adenocarcinoma (SMARCA4-dADC) is an aggressive and poorly differentiated subtype of non-small cell lung cancer (NSCLC), often lacking thyroid transcription factor-1 (TTF-1) expression and associated with poor prognosis. Optimal management for locally advanced SMARCA4-dADC remains unclear, as these tumors typically show limited response to conventional chemotherapy or immunotherapy. Reports of effective neoadjuvant strategies in this population are extremely rare. We report a 65-year-old male smoker diagnosed with stage cT3N2M0 (IIIA) SMARCA4-dADC, confirmed by immunohistochemistry showing SMARCA4 loss and programmed death-ligand 1 (PD-L1) tumor proportion score <1%. The patient received neoadjuvant chemoimmunotherapy followed by right upper lobectomy with systematic lymphadenectomy. Post-treatment imaging demonstrated a partial response (PR), with tumor size decreasing from 66 mm × 53 mm to 31 mm × 28 mm and clinical downstaging to ycT2aN0M0 (stage IB). Pathological evaluation of the resected specimen revealed a complete response, with 0% viable tumor cells in both the primary tumor and lymph nodes. The treatment was well-tolerated without delays or surgical complications. This case highlights the potential efficacy of neoadjuvant chemoimmunotherapy in achieving pathological complete response (pCR) in locally advanced SMARCA4-dADC, enabling tumor downstaging and curative resection. It represents one of the first reported instances of pCR in this rare NSCLC subtype and suggests that such an approach may provide a promising treatment option. Prospective studies are needed to validate these findings and guide clinical practice.
Endoscopic nipple-sparing mastectomy (E-NSM) with immediate implant reconstruction is increasingly adopted to preserve breast appearance and quality of life. Immune checkpoint inhibitors (ICIs) and poly (ADP-ribose) polymerase (PARP) inhibitors have substantially improved survival in BRCA-mutated triple-negative breast cancer (TNBC). However, the safety of sequential olaparib following concurrent pembrolizumab and radiotherapy in patients with pre-pectoral breast reconstruction remains poorly defined, and the risk of severe cutaneous toxicity and implant loss is underrecognized. We herein report the case of a 31-year-old female who presented with a chief complaint of palpable masses in the left breast and ipsilateral axilla. Diagnostic core needle biopsies of the primary breast lesion and axillary lymph node were conducted, and histopathological examination confirmed invasive TNBC with ipsilateral axillary lymph node metastasis. Germline genetic testing further revealed a pathogenic BRCA1 mutation. After completion of multidisciplinary neoadjuvant systemic therapy, the patient underwent E-NSM with immediate pre-pectoral prosthetic breast reconstruction. Postoperatively, the patient received adjuvant pembrolizumab followed by locoregional radiotherapy. Although only grade 2 radiodermatitis (RD) was initially observed, the subsequent initiation of adjuvant olaparib triggered a rapid and catastrophic clinical deterioration. Within one week of commencing olaparib, the patient's condition progressed to grade 4 severe RD, characterized by extensive full-thickness skin necrosis and eventual implant extrusion, necessitating surgical explantation. This case highlights catastrophic synergistic cutaneous toxicity and implant loss caused by the sequential combination of pembrolizumab, radiotherapy, and olaparib in patients with pre-pectoral breast reconstruction. Olaparib serves as the dominant pathogenic factor, delivering a lethal "second hit" by inhibiting DNA repair in radiation-sensitized, hypovascular skin flaps overlying the implant. Weekly skin toxicity monitoring is mandatory from the initiation of radiotherapy until at least 2 months after the completion of radiotherapy. Pembrolizumab and olaparib should be initiated only after a mandatory washout period of 2 months following the end of radiotherapy, with monitoring performed every 1 to 2 weeks throughout the treatment course. No additional systemic anti-tumor agents shall be administered concurrently with radiotherapy. Upon detection of early skin reactions, prompt intervention with topical corticosteroids and temporary olaparib interruption is indicated, tailored to toxicity severity.
Metastatic melanoma remains a therapeutic challenge despite major advances in immunotherapy and targeted therapies. Immune checkpoint inhibitors and BRAF/MEK inhibitors have improved survival in selected patients; however, their use may be limited by immune-related adverse events, acquired resistance, deterioration in quality of life, and economic burden. Intraperitoneal ozone therapy (IPO3) has been described as a feasible and well-tolerated complementary approach in advanced oncologic settings, although clinical evidence remains limited. This case report describes the clinical and metabolic evolution of a patient with refractory metastatic melanoma treated with high-dose IPO3 after progression under immunotherapy and intolerance to targeted therapy. A 66-year-old woman with a history of cutaneous melanoma developed extensive metastatic disease involving subcutaneous, muscular, pulmonary, pleural, and left adrenal sites. Disease progression was documented after adjuvant pembrolizumab, and targeted therapy with dabrafenib plus trametinib was discontinued because of clinically significant systemic toxicity. In June 2024, the patient initiated high-dose IPO3. Serial positron emission tomography-computed tomography (PET-CT) scans showed sustained disappearance of pathological hypermetabolic uptake in previously affected systemic sites, with isolated persistence and oscillation of metabolic activity in the left adrenal lesion. Additional IPO3 cycles were administered, and focal radiotherapy was directed to the persistent adrenal lesion. Treatment was clinically well tolerated, with no significant adverse events. Progressive functional improvement was documented, with Karnofsky performance status increasing from 60% at treatment initiation to 90% during follow-up. In this case, high-dose IPO3 was temporally associated with sustained systemic metabolic remission and objective functional improvement in refractory metastatic melanoma. Although a causal relationship cannot be established from a single observation, these findings support further prospective studies to evaluate the safety, efficacy, and potential immunometabolic mechanisms of IPO3 as a complementary strategy in selected oncologic scenarios.