International Journal of Cancer Research and Molecular Mechanisms

4

Authors: Akdemir O

Background: Locally advanced rectal cancer is defined as a rectal mass that cannot be resected without a high probability of leaving residual disease at the tumor site. While the standard treatment for locally advanced rectal cancer is chemoradiotherapy followed by surgery, this study reports a locally invasive rectal adenocarcinoma patient who achieved complete pathological and clinical remission after receiving a combination of metabolically supported chemotherapy (MSCT), radiotherapy (RT) and hyperthermia (HT). Case presentation: An 81-year-old female underwent a rectosigmoidoscopy at a referring hospital following a complaint of bloody stools for a period of 20 days. The rectosigmoidoscopy revealed an ulcerated tumor beginning at the level of the anal sphincter. A pathological examination of biopsy material revealed moderately differentiated invasive adenocarcinoma and the patient received a diagnosis of stage III (T3N2M0) lowlying rectal cancer. When further follow-up revealed colonic obstruction, the patient was recommended an abdominoperineal resection (APR) and was referred after refusing surgical treatment. The patient received a metabolically supported combination of oxaliplatin, 5-florouracil (5-FU) and calcium folinate (FOLFOX6) concomitant to RT and local HT and, ultimately, never underwent surgery. 27 months since her disease-free PET-CT scan, the patient remains with no sign of disease recurrence. Conclusion: According to the findings of the present study, the non-surgical treatment and achievement of complete clinical and pathological remission of locally advanced rectal adenocarcinoma may be possible by means of a combination of MSCT, RT and HT.

4

Authors: Uy AB

Lymphoma and tuberculosis (TB) share common features, thus misdiagnoses are commonly encountered. The Philippines is ninth out of the 22 countries in the world with the highest TB-burden, while lymphoma has age-standardized rates of 4.6/100,000 population in all ages in Manila. This study reports a case of a 24-year-old HIV-negative male presenting with a six-month course of anorexia, weight loss, fever, night sweats, and hepatosplenomegaly. Heamatologic studies revealed anemia. Bilirubins, alkaline phosphatase, and lactate dehydrogenase were elevated, while transaminases were normal. Initial chest X-ray showed nodular infiltrates on both lung apices and a negative sputum acid-fast bacilli smear. Contrast-enhanced computed tomography (CT) scan of the chest and abdomen revealed multiple tiny, non-calcified pulmonary parenchymal nodules on both lung fields, marked hepatomegaly with multiple nodules in the portahepatic, retroperitoneal and mesenteric region consistent with lymphadenopathies; and splenomegaly with intraparenchymal cystic nodules. Primary considerations were gastrointestinal lymphoma versus TB. The patient was diagnosed late with severe disseminated TB affecting the lungs, liver, spleen, genitourinary tract and intestines. No anti-TB treatment was started within the patient’s six-month course because of uncertainty in the diagnosis, especially in light of the negative sputum acid-fast bacilli smears. Malnutrition, anemia, hypoalbuminemia, and an overall immune compromised state contributed to the demise of the patient while undergoing surgery for a ruptured viscus from ileocecal TB invasion. TB is a disease that can be easily controlled and treated. The decision to start empiric treatment with anti-TB medications has a higher benefit versus risk of complications, especially in a patient with a high index of suspicion for the disease.