BackgroundWe report a single institution’s experience from a small series of patients suggesting that liver metastasis in metastatic castration-refractory prostate cancer (mCRPC) represents a relatively aggressive subtype that is refractory to hormonal manipulation treatment, including luteinizing hormone-releasing hormone agonist (LA) and abiraterone (Ab) therapy, although docetaxel is briefly effective.MethodsBetween 2007 and 2013, six patients with prostate cancer with liver metastases were analyzed. Biochemical response was defined as > 50% decrease in prostate-specific antigen (PSA) value.ResultsTwo patients who presented with liver metastases died in less than 3 months after LA therapy. Two out of three patients (one died while receiving chemotherapy) received Ab after chemotherapy did not show any response and died while on therapy. One patient who presented with lung metastases initially received LA therapy and progressed on it with liver metastases in < 6 months. Thus, five of six patients did not respond to hormone therapy including LA and Ab. Three patients who received docetaxel after LA therapy had more than 50% objective PSA response with a mean survival of 4 months.ConclusionsNo literature addresses the response to hormone treatment in hepatic metastasis in prostate carcinoma. This small series suggests that liver metastases in prostate carcinoma represent a relatively aggressive subset against which hormonal therapy, including the LA and Ab, appears to be ineffective. Although our patients responded to docetaxel chemotherapy, their responses were of short duration. A further clinical trial involving more patients will be necessary to substantiate our findings.
Sporadic Burkitt lymphoma (BL) accounts for 1% to 2% of lymphomas in adults. The abdomen is the most common site of involvement. The 2008 World Health Organization Classification of Tumors of Haematopoietic and Lymphoid Tissues introduced a new category of high-grade B-cell lymphomas: an entity with overlapping features of both diffuse large B-cell lymphoma and Burkitt lymphoma (DLBCL/BL). These lymphomas reportedly have poor overall survival rates. We present a case of an elderly adult atypical sporadic BL with jaw and bone marrow involvement. The tumor had the typical characteristic of BL including atypical monotonous lymphoid infiltrate with a starry-sky appearance and a high Ki67 proliferate index of 95%. MYC/IgH rearrangement was seen in 93.5% of the cells with 92% of cells also positive for IgH/Bcl-2, a feature of double-hit lymphoma. This atypical case of adult sporadic BL had features as classified of DLBCL/BL. Though high intensity regimen is used in BL and atypical BL, elderly patients tend to not tolerate these regimens well. Our patient was treated with bendamustine and bituximab given herelderly age and poor cardiac status. The patient responded well to chemotherapy and remains in complete remission two years after diagnosis up to the date of this report. The atypical presentation and excellent response to bendamustine plus rituximab has not been previously reported.
e16101 Background: Prostate cancer exhibits distinct pattern of metastasis with bone being the most common site of involvement. Liver is an uncommon site of metastasis and is associated with poor prognosis. Very few data is available on treatment with hormone including LHRH agonist (LA) and abiraterone (Ab) and chemotherapy. We retrospectively reviewed data of patients with liver metastasis with the primary objective of determining their clinical characteristics and treatment outcome from a single institution experience. Methods: Data of 5 patients with prostate cancer who developed liver metastases during the course of their disease was collected between 2007 and 2013. Four out of five patients had histological confirmation of prostatic origin adenocarcinoma while one had radiological confirmation. All patients except one had received prior LA and all were chemotherapy naïve prior to development of liver metastases. Objective biochemical response was defined as >50% decrease in PSA value following therapy. Results: Gleason score was >8 in 4/5 patients and unknown in one. Three out of five patients who progressed on LA received docetaxel, and despite achieving a more than 50% objective PSA response in all patients, it was of short duration, the mean duration of response was only 6 months. Two patients received Ab, after chemotherapy with docetaxel ,did not show any response and another two patients received LA therapy also failed ( one patient who presented with lung metastases developed liver metastases in <6 months; one patient who presented with liver metastases expired in <3 months despite LA therapy). Thus, four of five patients in this small series did not respond to hormone therapy. Conclusions: From this small series of study, it suggests that liver metastases in carcinoma of prostate represent an aggressive subset that does not respond to hormonal therapy including the LHRH agonist and abiraterone. Although they responded to docetaxel chemotherapy, the responses were of short duration. An alternative regimen should be explored for this particular subset of patients.
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