Gastrointestinal Cancer Educational Case Series: Management of Metastatic Adenocarcinoma of Unknown Primary Origin in a
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MGMT. OF COMPLEX CASES IN GI ONCOLOGY
Gastrointestinal Cancer Educational Case Series: Management of Metastatic Adenocarcinoma of Unknown Primary Origin in a Ph+ ALL Survivor Celina Ang & Eileen M. O’Reilly & Ghassan K. Abou-Alfa & Ali Shamseddine & Hadi Skouri & Ayman Tawil & Mohamad A. Eloubeidi & Maeve Lowery & Mohamed Kharfan-Dabaja & Tania Kaprealian & Sally Temraz & Hassan Sibai & Hassan Farran & Manish A. Shah
Published online: 3 December 2010 # Springer Science+Business Media, LLC 2010
Abstract Introduction Secondary malignancies and chronic endorgan sequelae are significant and steadily rising consequences of cancer therapy. The workup and management of a carcinoma of unknown primary must consider the patient’s clinical presentation, radiologic and pathologic findings, and comorbidities. Case Report We present the case of a 50-year-old female survivor of Philadelphia chromosome-positive acute lymphoblastic leukemia (Ph+ ALL) with significant treatmentrelated end-organ sequelae who developed a metastatic adenocarcinoma of unknown primary 15 years following curative therapy for her ALL. The complex management issues related to the investigations and choice of therapy for this patient are reviewed. Discussion This case discusses key issues related to the
C. Ang : E. M. O’Reilly : G. K. Abou-Alfa : M. Lowery : M. A. Shah Memorial Sloan-Kettering Cancer Center, New York, NY, USA A. Shamseddine : H. Skouri : A. Tawil : M. A. Eloubeidi : M. Kharfan-Dabaja : T. Kaprealian : S. Temraz : H. Sibai : H. Farran American University of Beirut, Beirut, Lebanon E. M. O’Reilly (*) Department of Medicine, Gastrointestinal Oncology Service, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA e-mail: [email protected]
workup and management of a carcinoma of unknown primary. In addition, it illustrates the importance of taking patient comorbidities into consideration and tailoring investigations and therapy accordingly. Keywords Carcinoma of unknown primary management . Carcinoma of unknown primary investigations . Secondary malignancies . Cancer therapy-induced cardiotoxicity
Case History Dr. Ang (New York) A 50-year-old female was incidentally found to have multiple pulmonary and hepatic nodules while being managed for a congestive heart failure (CHF) exacerbation. Her past medical history was significant for Philadelphia chromosome-positive acute lymphoblastic leukemia (Ph+ ALL) diagnosed 15 years earlier and treated with induction and consolidation chemotherapy consisting of cytarabine, L-asparaginase, vincristine, etoposide, mitoxantrone, and prednisone. She also received intrathecal methotrexate. Upon relapse approximately a year later, she was treated with cyclophosphamide and total body irradiation followed by an allogeneic bone marrow transplant which resulted in a durable complete remission. As a result of therapy, however, she developed multiple end-organ sequelae, the most significant of which was dilated cardiomyopathy with an ejection fraction of 24% requiring placement of a pace
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