Background: The rectum is an uncommon site for metastases from Invasive Ductal Carcinoma (IDC) of the breast, and it poses risks such as perforation and obstruction. Case Report: A 50-year-old non-diabetic, non-alcoholic, and nonsmoker premenopausal female patient diagnosed with rectal metastasis primarily originating from breast cancer. In 2009, the patient was diagnosed with stage IV hormone positive, Her-2 (+2) negative, FISH positive right breast cancer with cervical (C6) vertebrae metastasis seen on PET scan. As she had oligo metastasis with a single bony focus, she was treated with intent to cure. For this purpose, she received radiation therapy to the cervical vertebrae, resulting in a complete response. This was followed by pseudo-neoadjuvant chemotherapy with six cycles of Docetaxel and trastuzumab. The patient then underwent a right-modified radical mastectomy. The pathology showed no complete response with residual 2.5 cm invasive carcinoma (PT2), and 4 out of 25 Axillary lymph nodes were positive for metastases (PN2). She was given (pseudo) adjuvant radiotherapy to the chest wall and lymphatics and was started on (pseudo) adjuvant tamoxifen. Trastuzumab was completed for one year as a (pseudo) adjuvant setting. Her disease seemed to be cleared up as no new cancer signs were reported by follow-up full body scans (CT/PET). After seven years, in May 2016, her PET-CT scan showed multiple new hypermetabolic osseous lesions, in keeping with metastasis involving the right shoulder, mid-thoracic spine, left aspect of L5, right sacrum, and the greater trochanteric region of the left femur and left ischium. She also presented a new hypermetabolic retroperitoneal paracaval lymph node, in keeping with metastasis. The new ill-defined hypodensity in the left hepatic lobe was associated with increased FDG uptake, which is suspicious for early metastasis. She also presented a tiny right lung peri-fissural nodularity that was too small to be characterized by PET. She was treated with Zoladex 3.6 mg injection monthly, Femara 2.5 mg daily, Palbociclib 125 mg PO daily for 21 days over a 28-day cycle, and Denosumab 120 mg monthly. The treatment was initiated in Singapore. As previously stated, Her-2 testing was reported as negative. The patient went into complete remission for more than six years, as documented by the PET scan conducted on January 19, 2022. Later, in June 2022, the patient developed signs and symptoms of intestinal obstruction (abdominal pain, nausea, and vomiting) and was diagnosed with rectal cancer metastases of breast origin. Conclusion:  As the patient first developed breast cancer with oligo-bony metastasis, which was successfully treated with chemotherapy and radiotherapy, but later relapsed in the lung, liver, lymph nodes, and multiple bony sites. She was treated successfully via hormonal and targeted therapy. Finally, she relapsed in the form of rectal metastasis.

No abstract

Objective and Importance: To report the case of a 23-year-old woman with widespread osteosarcoma including skeletal, pulmonary and pleural metastases, who had a remarkable response to combined chemo- and radiotherapy. Clinical Presentation and Intervention: A 23-year-old Indonesian woman presented in October 1999 with a swelling of the right thigh, severe generalized pain and progressive left hemiparesis. Radiological examination revealed osteolytic lesions in the cervical spine. CT scan of the chest showed multiple pulmonary metastases and a huge left pleural effusion. Bone scan with technetium-99m hydroxymethylene diphosphonate showed intense uptake of the radiopharmaceutical in the distal right femur, generalized deposits throughout the skeleton and in the right hemithorax corresponding to the lung findings. Bone marrow and kidney function tests as well as serum calcium level were normal. Alkaline phosphatase was markedly elevated, 8,000 IU/l (normal <250 IU/l). Histopathology from the femoral tumor showed osteosarcoma. Treatment was started with radiotherapy to the cervical spine followed immediately by a combination chemotherapy with ifosfamide, cisplatin, etoposide and mesna rescue. In addition, the patient received bisphosphonates regularly. Eleven cycles of chemotherapy were given with a remarkable response. Conclusion: The patient was successfully treated with a combination of radio- and chemotherapy. She recovered fully and is in almost complete remission. The disease remained stable 24 months after the discontinuation of the treatment.

Background: Metastasis of the Central Nervous System (CNS) is one of the frequently occurring complications of advanced Non-Small Cell Lung Cancer (NSCLC) and has been observed in 24–44% of patients. Patients suffering from NSCLC along with CNS metastases have a generally poor prognosis. Case Report: A 57-year-old nonalcoholic, non-diabetic, heavy smoker male patient was diagnosed with stage IV NSCLC (non-small cell lung cancer) (Adenocarcinoma), PD-L1 expression 80% with liver, spleen, and brain metastases. In June 2016, the patient was diagnosed with Stage III-A EGFR wild right-sided lung adenocarcinoma (T4N0M0), for which he underwent Curative Concurrent chemo-radiotherapy in Jordan, followed by two cycles of Etoposide plus CDDP (Cisplatin). In February 2017, the patient came to the hospital with the chief complaint of massive hemoptysis. His CT scan showed an appearance in keeping with the right upper-lobe cavitating tumor with possible contralateral lung, splenic, and hepatic metastases. The patient was offered pneumonectomy but refused it. Interventional radiology (IR) tumor embolization of the apical and posterior (A1 and A2) branches of the right superior pulmonary artery with no procedural complication was performed to stop the bleeding. At the end of that same month, on February 28, 2017, he presented to emergency with seizures, for which a contrast CT scan showed two enhancing lesions, one of the left parietal lobe posteriorly 1.8 cm with marked white matter oedema causing a mass effect and the effacement of the posterior horn of the left lateral ventricle. The second is a small ring-enhancing deposit of the right occipital lobe 6 mm with surrounding oedema. The liver biopsy failed to show any malignancy. After the MDT discussion, the largest lesion in the brain was removed and a small lesion was kept. The left occipital metastasis was resected and was found to be a metastatic adenocarcinoma of lung origin. It was positive for TTF-1 and positive for Moc 31. P63 and CK5/6 were negative (no squamous component is seen). No brain radiotherapy was offered. First-line palliative Nivolumab was started on March 20, 2017. Nivolumab first proved to be highly successful against brain metastases. However, it was discontinued as the patient developed myelitis after seven months of continuous treatment. After the discontinuation and improvement of myelitis symptoms, Nivolumab was resumed. The amazing thing about this treatment approach was that his disease was completely cleared up and he had been in complete remission for five years. Additionally, all of his tumor indicators had decreased and normalized. Conclusion: Our case report demonstrated a full response to first-line Nivolumab in a patient with PD-L1-positive NSCLC having visceral and brain metastases. However, our patient suffered from myelitis, which may have been a Nivolumab-related adverse event. The important point is that he has been achieving a durable complete response for nearly 5 years, so are we talking about the certain biology of a tumor that can be cured by immunotherapy?

This a preprint and has not been peer reviewed. Data may be preliminary.