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Summary Ectopic ACTH-secreting pulmonary neuroendocrine tumors are rare and account for less than 5% of endogenous Cushing’s syndrome cases. We describe an unusual case of metastatic bronchial carcinoid tumor in a young woman presenting with unprovoked pulmonary emboli, which initially prevented the detection of the primary tumor on imaging. The source of ectopic ACTH was ultimately localized by a Gallium-DOTATATE scan, which demonstrated increased tracer uptake in a right middle lobe lung nodule and multiple liver nodules. The histological diagnosis was established based on a core biopsy of a hepatic lesion and the patient was started on a glucocorticoid receptor antagonist and a somatostatin analog. This case illustrates that hypercogulability can further aggravate the diagnostic challenges in ectopic ACTH syndrome. We discuss the literature on the current diagnosis and management strategies for ectopic ACTH syndrome. Learning points: In a young patient with concurrent hypokalemia and uncontrolled hypertension on multiple antihypertensive agents, secondary causes of hypertension should be evaluated. Patients with Cushing’s syndrome can develop an acquired hypercoagulable state leading to spontaneous and postoperative venous thromboembolism. Pulmonary emboli may complicate the imaging of the bronchial carcinoid tumor in ectopic ACTH syndrome. Imaging with Gallium-68 DOTATATE PET/CT scan has the highest sensitivity and specificity in detecting ectopic ACTH-secreting tumors. A combination of various noninvasive biochemical tests can enhance the diagnostic accuracy in differentiating Cushing’s disease from ectopic ACTH syndrome provided they have concordant results. Bilateral inferior petrosal sinus sampling remains the gold standard.

BackgroundThis study aimed to evaluate the predictive value of presurgical factors for psychiatric disorders (PD) in refractory temporal lobe epilepsy and mesial temporal sclerosis (TLE‐MTS) patients underwent cortico‐amygdalohippocampectomy (CAH).MethodsA total of 98 refractory TLE‐MTS patients underwent CAH were consecutively enrolled in this cohort study. Several presurgical factors were recorded, such as married status, employment status, highest education, disease duration, family history of epilepsy, and disorganized VEEG background activity.ResultsThere were 17 (17.3%) refractory TLE‐MTS patients occurring PD after CAH, including 8 (8.2%) mood disorders, 7 (7.1%) anxiety disorders, 8 (8.2%) psychoses, and 1 (1.0%) interictal dysphoric disorder. Employed status correlated with low PD occurrence, while disease duration and asymmetric VEEG background activity positively correlated with PD occurrence. Multivariate logistic analysis revealed employed status (P = 0.009) could independently predict lower PD occurrence, while highest education (P = 0.027), disease duration (P = 0.028), seizure frequencies (P = 0.015), and asymmetric VEEG background activity (P = 0.034) could independently predict higher PD occurrence. Receiver operating characteristic curve showed combination of these five factors (area under curve (AUC) = 0.871, 95%CI: 0.783‐0.960) disclosed a great predictive value of PD occurrence. The sensitivity and specificity were 70.6% and 92.6% at the best cutoff point. In addition, the percentage of PD was increased with higher Engel classification (P = 0.003).ConclusionEmployed status, highest education, disease duration, seizure frequencies, and asymmetric VEEG background activity correlate with PD occurrence independently in epileptic patients.

e16084 Background: The introduction of immune checkpoint inhibitors (ICIs) after chemotherapy and targeted therapy has altered the treatment pattern of esophageal squamous cell carcinoma (ESCC). However, using ICIs alone results in a poor response rate. Fortunately, fundamental research indicates that chemotherapy might trigger immunogenic death of tumor cells by releasing tumor antigens, hence eliminating immune system repression of tumor cells. On this basis, a number of clinical studies, including KEYNOTE-590, CheckmMate-648, ORIENT-15, and ESCORT-1st, on the first-line treatment of ESCC with ICIs coupled with chemotherapy, including fluorouracil or taxol and platinum (PF or TP), were conducted and yielded favorable results. However, the advantage of safety and effectiveness of ICIs combination with PF and TP in Chinese ESCC remains unknown. Furthermore, since the southeast part of Shanxi province has a high prevalence of esophageal cancer, the geographical features of ESCC patients will be examined. Methods: Camrelizumab was maintained after 6 cycles of camrelizumab in combination with PF or TP chemotherapy. From May 2020 to February 2022, our study has included 40 locally progressed and advanced ESCC patients. Camrelizumab was administered in combination with PF to 11 patients and TP to 29 patients. Every 6 weeks, efficacy was examined using RECIST 1.1, and 33 patients were evaluated. This research was registered with the Chinese Clinical Trials Registry (ChiCTR2000037942). Results: The median treatment time was 5.8m. 82.5% (33/40) patients were availably evaluated. The objective response rate (ORR) was 72.7% (24/33) and the disease control rate (DCR) was 97.0% (32/33). There is no statistically significant difference in ORR ( p=0.1779) and DCR ( p=0.1005) between PF and TP (55.6% vs 79.2%, 88.9% vs 100%) regimens. At this moment, mPFS has not been achieved. The most common adverse events (AEs) were anemia (22.5%, 9/40), lymphocytopenia (15%, 6/40), neutropenia(15%, 6/40), reactive cutaneous capillary endothelial proliferation (RCCEP) (12.5%, 5/40) and fatigue (7.5%, 3/40). Thrombocytopenia (2.5%, 1/40), neutropenia (2.5%, 1/40) and leukopenia (2.5%, 1/40) were the most common grade 3 or 4 toxicities The most frequently reported immune-related AEs were RCCEP (12.5%, 5/40) and hypothyroidism (7.5%, 3/40). There were no new significant adverse events. Conclusions: Camrelizumab in combination with chemotherapy is a promising regimen with good tolerability in the first-line treatment of ESCC. Compared with FP, TP had more therapeutic advantages, But the result is a stage summary, and further observation is needed. Clinical trial information: ChiCTR2000037942. [Table: see text]