Adenocarcinoma arising from a foregut cyst of the diaphragm: importance of multimodality treatment: a case report
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CASE REPORT
Adenocarcinoma arising from a foregut cyst of the diaphragm: importance of multimodality treatment: a case report Jozsef Furak1*†, Anna Rieth2†, Aurel Ottlakan1, Tibor Nemeth1, Laszlo Torday3, Laszlo Tiszlavicz4 and Gyorgy Lazar1
Abstract Background: Benign foregut cysts usually develop in the thorax most of all in the mediastinum. Rare cases involving various abdominal organs, such as liver, stomach or pancreas have been previously published, mostly occurring in the retroperitoneum. Case presentation: We herein present an adenocarcinoma of a foregut cyst involving the left side of the diaphragm, left lower lobe of the lung, and left lobe of the liver, successfully removed through multivisceral resection. In between drug holidays, postoperative oncological treatment has been ongoing for nearly 4 years. In terms of chemotherapy, FOLFOX 4 regime, capacitabine monotherapy and later on next generation sequencing has been attempted, although the patient refused the later treatment option. Despite multimodality (combined surgical and oncological) treatment, local- and later on loco-regional recurrence has been detected on follow-up staging, influencing further chemotherapy regime. Taking both the fairly unknown type of the tumor and uncertain response rate to oncological therapy into account, prolonged tumor pace with fairly stable general patient state was reached throughout the course of the disease. Conclusion: Through surgical tumor resection, and postoperative chemotherapy the patient managed to maintain an acceptable quality of life without major symptoms during ongoing treatment. During our own case, with multiple organ involvement, multivisceral resection, with multimodality treatment had considerable effect in prolonging the lifespan of the patient. Keywords: Foregut cyst, Diaphragm, Adenocarcinoma, Multivisceral resection, Multimodality treatment Background Until recently, about 200 primary diaphragm tumors have been reported worldwide [1]. Primary benign lesions include mesothlial cysts, mostly occurring in children, and tumors arising from bronchogenic cysts [2]. The most frequent benign tumors of the diaphragm *Correspondence: [email protected]‑szeged.hu † Jozsef Furak and Anna Rieth have equally contributed to the present manuscript as first authors 1 Department of Surgery, Faculty of Medicine, University of Szeged, Semmelweis str. 8, Szeged 6725, Hungary Full list of author information is available at the end of the article
include lipomas, with the first case reported in 1886, by Clark [3]. However, benign lesions, such as lipomas may in some percentage transform into liposarcomas, thus resection of these seemingly harmless lesions is in most cases mandatory [4]. Malignant diaphragm lesions include rhabdomyosarcomas, usually with poor prognosis, although patients often benefit from the combination of surgical resection, chemotherapy and postoperative irradiation [5]. Leiomyosarcomas occur relatively rare at the site of the diaphragm, leaving only surgical resection as a fea
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