Patient: Male, 67-year-old Final Diagnosis: Lung adenocarcinoma Symptoms: Abdominal pain Medication:— Clinical Procedure: Lobectomy Specialty: Oncology • Pathology Objective: Rare co-existance of disease or pathology Background: The occurrence of metastasis from one neoplasm to another is known as tumor-to-tumor metastasis (TTM). It is a rare phenomenon in the natural history of any neoplasm, with approximately 100 cases reported in the literature to date. The lungs are the most frequent metastatic tumor donors and kidney cancer is the most common recipient. However, the opposite phenomenon (lung adenocarcinoma as a recipient of metastasis from renal carcinoma) has not been previously reported in the literature. Case Report: We present the case of a man with a history of multiple neoplasms. He had a diffuse large B-cell lymphoma in 2006, a left papillary renal cell carcinoma (RCC) type 2 in 2006, and an acinar adenocarcinoma of the prostate in 2011. A follow-up computed tomography scan in July 2019 showed a suspicious lung nodule on the left upper lobe and a retroperitoneal hypermetabolic mass on the positron emission tomography scan. The lung nodule and retroperitoneal mass biopsies were consistent with a primary lung adenocarcinoma with a lepidic pattern and a metastatic RCC, respectively. In January 2020, he underwent a thoracoscopic left upper lobectomy and a mediastinal lymph node dissection. Histopathological evaluation revealed a 2-cm nodule composed of a lung adenocarcinoma with an intratumoral metastasis from a papillary RCC. To date, the patient has stable renal neoplastic metastatic disease and no locoregional recurrences of the lung adenocarcinoma. Conclusions: Metastasis from one primary tumor to another primary tumor is an extremely unusual event. We report one of the first cases of an RCC metastasis to a primary lung adenocarcinoma.

PurposeMediastinal germ cell tumors (GCT) are rare neoplasms associated with poor survival prognosis. Due to their low incidence, limited information is available about this disease in South America. The objective of this study is to report the clinical characteristics and outcomes of patients with mediastinal GCT in a cancer center in Colombia.Materials and MethodsWe conducted a retrospective analysis of patients with mediastinal GCT treated at the National Cancer Institute at Bogota (Colombia) between 2008 and 2020. Survival curves were presented using the Kaplan–Meier method. Chi-square and Cox proportional hazard model tests were used for data analysis.ResultsSixty-one patients were included in the study. Of them, 60 were male and 51 (83.6%) of whom had non-seminomatous germ cell tumors (NSGCT). Twenty-nine patients (47.5%) presented with superior vena cava syndrome, and 18 (29.5%) patients had extrapulmonary metastatic involvement. The three-year overall survival (OS) of NSGCT patients was 26%. The 3-year OS of NSGCT patients who underwent surgical resection of residual mediastinal mass after chemotherapy was 59%. Non-surgical management after first-line chemotherapy was associated with a worse survival prognosis in NSGCT patients (p = 0.002). Ten patients with mediastinal seminomatous germ cell tumors (SCGT) achieved a 3-year OS of 100%.ConclusionMediastinal NSGCT had poor outcomes. Surgery of the residual mass after first-line chemotherapy seems to improve the outcome of NSGCT patients. Advanced disease at presentation may reflect inadequate access to reference cancer centers in Colombia and potentially explain poor survival outcomes in this cohort. On the other hand, mediastinal SCGT is a biologically different disease; most patients will achieve disease remission and long-term survival with first-line chemotherapy.

Objective To describe the survival outcomes of metastatic non-small cell lung cancer patients with limited access to immunotherapy and targeted therapy in a cancer reference center in Colombia. Methods A retrospective analysis of metastatic non-small cell lung cancer patients treated between 2013 and 2018 was performed, majority diagnosed with adenocarcinoma. It was carried out in a public cancer reference center that provides care to patients of low and middle socioeconomic status. Overall survival and progression-free survival were evaluated by Kaplan–Meier analysis and log-rank test. A Cox regression model was performed for univariate and multivariate analysis. Results 209 patients were included with majority of adenocarcinoma (79.5%). First-line treatment was cytotoxic chemotherapy (50.2%), EGFR-targeted therapy (14.8%), chemoimmunotherapy (1.9%), and ALK-targeted therapy (1.4%). 31.6% received best supportive care. Median time of follow-up was 13 months, median overall survival was 11.2 months (95% CI, 7.9–14.4), 13 months for adenocarcinoma (95% CI, 8.1–17.9), and 2.5 months for squamous cell carcinoma (95% CI, 0.6–4.4) ( P < .001). Median progression-free survival was 9.3 months (95% CI, 7.9–10.7) without differences according to the type of first-line therapy. Median time-to-treatment was 55 days and only 54% of patients with a tested actionable mutation in EGFR received an EGFR-targeted therapy as the first-line treatment. Multivariate analysis showed that squamous cell carcinoma histology and receiving best supportive care were independent factors for worse overall survival ((HR:1.8, 95% CI, 1.076–3.082, P=.026) and (HR:14.6, 95% CI, 8.921–24.049, P < .001), respectively). Meanwhile, squamous cell carcinoma histology was an independent factor for worse progression-free survival (HR:3.4, 95% CI, 1.540-7.464, P=.002). Conclusions Despite advances in precision medicine, during the study period, cytotoxic chemotherapy was the most used treatment in our patients. Furthermore, about a third of them received best supportive care. The use of targeted therapies has been restricted by access to molecular diagnosis and remained low until 2018. Access to immunotherapy should be prioritized.

Objetivo: El objetivo fue describir la etiología de los falsos positivos del 18 F-FDG PET/CT y sus asociaciones con características clínicas e imagenológicas en los pacientes oncológicos sometidos a biopsia quirúrgica de ganglios mediastinales e hiliares, en el Instituto Nacional de Cancerología, en un periodo de 8 años. Métodos: Estudio retrospectivo y analítico. Resultados: Se incluyeron 93 pacientes con una mediana de edad de 64 años (RIC:55-70) y 57% eran mujeres. 35,5% de los pacientes tenía cáncer de pulmón, seguido de linfoma en 21,5%. 43% de los pacientes eran fumadores y 17,2% tenían exposición por combustión de biomasa. De los 93 pacientes, se biopsiaron 220 estaciones ganglionares mediastinales e hiliares. 37 (16,8%) estaciones ganglionares correspondieron a falsos positivos del 18F-FDG PET-CT. La etiología fue antracosis en 19 (51,4%) estaciones, sarcoidosis en 8 (21,6%) estaciones, negativo para malignidad en 7 (18,9%) estaciones, y solo dos estaciones fueron granulomas. Se encontró una asociación estadísticamente significativa entre los falsos positivos con las estaciones ganglionares de los pacientes ≥ 65 años (P=0,008) y pacientes con antecedente de tabaquismo (P=0,021). Además, una asociación entre los verdaderos positivos y las adenomegalias (P=0,033). Conclusiones: La principal etiología de los falsos positivos del 18F-FDG PET-CT fue antracosis. En cambio, los granulomas no fueron una etiología importante. Se encontró una asociación entre los falsos positivos con las estaciones ganglionares de los pacientes ≥ 65 años y pacientes con antecedente de tabaquismo. Además, se encontró la misma asociación entre los verdaderos positivos y los ganglios de las estaciones considerados adenomegalias en el 18F-FDG PET-CT.

Objetivo: el objetivo es describir el manejo y la respuesta de una paciente con adenocarcinoma multifocal y mutación del exón 19 del EGFR que incluyó cirugía, radiocirugía e inhibidores de tirosina quinasa.