A 68-year-old man develops acute hepatocellular injury during treatment with direct-acting antiviral agents (DAA) for hepatitis C. Medical history reveals the intake of tamoxifen as adjuvant treatment for breast cancer, currently in remission. After stopping tamoxifen, despite the continuation of the anti-HCV agents, a complete resolution of liver injury occurs. This interesting case illustrates tamoxifen hepatotoxicity induced by CYP3A4 interaction with direct anti-HCV agents. It stresses the importance of checking for interactions before starting treatment for hepatitis C.
Neuroendocrine neoplasms (NENs) are a heterogenous group of tumors, arising from enterochromaffin cells, with different biological and clinical characteristics. Well-differentiated Grade 1 (G1) small intestinal NENs are often characterized by a slow progression rate and a good prognosis. Peritoneal carcinomatosis of a G1 digestive NEN is not a very common finding, and thus there is little published evidence regarding its progression and management. The complex, multistage interplay between the peritoneum and the metastasizing neuroendocrine cells is not well understood, and a reliable predictive tool to identify these patients earlier in their disease course is lacking. The present study describes the case of a 68-year-old woman presenting with an oligosymptomatic, stage IV, small intestinal G1 NEN (pTxpN1pM1) with synchronous liver metastases, multifocal mesenteric tumor deposits and a low Ki67 labeling index (1%). Over a period of 15 months, the patient developed rapidly progressive peritoneal metastatic disease with repetitive self-limiting obstructive symptoms and eventually succumbed to her illness. The present case report discusses the potential relationship between low-grade NEN, location of the primary tumor and the metastatic site, and also speculates on the role of the underlying subcellular mechanisms, specific micro-environment, spreading modalities and therapeutic strategy.
Clinical case presentationWe present the case of a 32-year-old Tunisian woman living in Belgium with a 5-year history of liver lesions. Her medical history is marked by two pregnancies, and pleural tuberculosis at the age of 23, treated by antitubercular agents. The lesions were incidentally discovered in 2013 on a CT scan during a workout because of postpartum fever. They measured 8, 28, and 11 mm, respectively, at segments 7, 5, and 6; based on both MRI and ultrasound, they were considered atypical. She was asymptomatic and put under surveillance with no precise diagnosis.An MRI in 2016, eight months after giving birth to her second child, showed no growth of the subcapsular lesions, however a change in signal intensity was noted for one of the lesions (Figure 1). This information, combined with her medical history of right pleural tuberculosis, led us to do an interferon-gamma release assay, that was positive. FDG-uptake on a complementary PET-CT was observed for the lesion at segment 6 (Figure 2). Laparoscopic resection was performed (Figure 3). The resection specimen consisted of a 2 cm cheesy white nodule with a fibrous cap (Figure 4). Histology revealed a caseating granuloma, with positive staining for acid-fast bacilli and a positive PCR for Mycobacterium tuberculosis (Figure 5). A diagnosis of hepatic tuberculoma was made, and quadruple antituberculous treatment was started.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.