Recently, metastatic renal cell carcinoma (mRCC) treatment has changed dramatically with the onset of new therapies against molecular targets replacing immunotherapy as standard treatment. We report the case of a 49-year-old patient with a moderately differentiated renal clear cell carcinoma without extracapsular extension who underwent radical nephrectomy. Eight months after surgery, he developed a thyroid metastasis which was also treated surgically with a hemithyroidectomy. Seventy-five months after nephrectomy, the patient presented an upper gastrointestinal bleeding due to a duodenal metastasis that infiltrates the head of the pancreas. The treatment applied was surgery by duodenopancreatectomy, with positive surgical margins in the pathologic study. In addition to this, the extension study showed lung metastases requiring initiation of systemic treatment with sunitinib. The patient presented an excellent response to treatment, showing complete clinical and radiological response at 5 months of treatment (RECIST criteria) and a disease-free survival of 48 months until now, without evidence of toxicity. RCC has the potential to metastasize to almost any location, but thyroid and duodenal metastases in RCC are extremely rare. Moreover, this case also highlights the good responses that can be achieved in terms of disease-free survival, low toxicity and quality of life in this new era of therapies against molecular targets.

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After breast-conserving treatment, the occurrence of ipsilateral breast tumor relapse raises the concern regarding whether it may represent two distinct types of lesion that it is important to define, a true recurrence (TR) or a new primary tumor (NPT). TR and NPT have different natural histories, prognosis, and in turn different implications for therapeutic management. We report the case of a 35-year-old woman who developed a breast invasive ductal carcinoma, which after receiving breast-conserving treatment with adjuvant chemotherapy, radiotherapy and hormone therapy, developed four years after an inflammatory carcinoma in the same breast, with different expression of immunohistochemical markers than the first breast cancer. The patient was treated with neoadjuvant chemotherapy that allowed the realization of a radical mastectomy with a complete pathological response. We describe the diagnostic and therapeutic approach of ipsilateral breast tumor relapses, along with a review of existing literature.

Background: Strategies to identify high risk individuals who may develop lung cancer are sorely needed. Radiographic screening has several drawbacks including cost, high false positive rate, and exclusion of never-smokers who account for up to 13% of new diagnoses. Sputum collection can be difficult in up to half of former smokers. Alternatively, saliva is readily available and easy to collect. We have previously shown high sensitivity and specificity in distinguishing newly diagnosed oral squamous cell carcinoma from matched controls (Li et al. Clin Cancer Res 2004). Others have shown a correlation of salivary and serum levels of soluble Her2/neu in women with breast cancer compared to benign tumor and healthy controls (Streckfus et al. Clin Cancer Res 2000). These studies led us to embark on a pilot study to validate mRNA expression on a gene exon array platform and to explore gene exon signatures discriminating between early-stage NSCLC and healthy controls. Methods: Saliva is currently being collected from healthy subjects ages 40-79, (current and former smokers [≥20 pack-year] and never-smokers [<100 cigarettes/lifetime] and histologically-confirmed, untreated stage I-II NSCLC patients along with a medical history questionnaire. Exclusion criteria included: active pulmonary infection within 6 months, steroid inhaler use ≥ 6 months, or history of other invasive cancer within past 5 years. A one-time saliva specimen is being obtained between 9-10 am to avoid diurnal variation, mixed with a RNA stabilization agent, and stored at -70˚C. RNA is then extracted, amplified, and hybridized to the Affymetrix Human Exon 1.0 arrays (which contain 1.4 million probe sets). Array data is analyzed after appropriate normalization. Results: As proof-of-principal of the value of the exon array discovery platform, saliva mRNA expression was performed on 18 healthy subjects [14 males (3 never-smokers), 11 females (8 never-smokers)]. All of whom were able to provide adequate sample for analysis. Our data demonstrate that we have successfully amplified salivary RNA, hybridized to the exon array and have developed the statistical and informatics tools to harness the diagnostic information. Using these developed tools and the healthy cohort of subjects, we have identified and validated gender-specific salivary exon signatures. Conclusions: Preliminary results with saliva mRNA exon-level expression profiling suggest that quality samples are easily obtainable and the technique is feasible. Updated results with NSCLC specimens will be presented. Supported by International Association for the Study of Lung Cancer Fellowship Award (GJW) and R01-DE15970-03 (DTW).