Herein we report the case of a 63-year-old female tourist who presented to our Emergency Department with complete rectal prolapse. She had complained of diarrhea with traces of blood and mucus and had experienced fatigue after hiking. After the initial evaluation, it became clear that prolapse bares a large rectal tumor as a leading point. The prolapse was reduced under general anesthesia, along with a tumor biopsy. Further workup confirmed locally advanced adenocarcinoma of the rectum, which was treated with neoadjuvant chemoradiation followed by curative surgery in another hospital after repatriation. Rectal prolapse affects people of all ages, but it is more common in older adults, particularly women. Treatment options vary depending on the severity of the prolapse and can range from conservative measures to surgical interventions. This case report highlights the importance of early recognition and appropriate management of rectal prolapse in the emergency setting and the possibility of an underlying malignancy.
Objective: Ovarian cancer has a dismal prognosis. Standard
treatment following surgery relies on platinum-based chemotherapy.
However, sizeable percentages of patients are unresponsive.
Identification of markers predicting response to chemotherapy might help
select eligible patients while sparing unresponsive ones
treatment-associated toxicity. Cancer/testis antigens (CTA) are
expressed by healthy germ cells and malignant cells of diverse
histological origin. This expression profile identifies them as
attractive targets of cancer immunotherapies. We analyzed correlations
between expression of MAGE-A10 and New York esophageal-1 cancer
(NY-ESO-1) CTAs at protein level and effectiveness of platinum-based
chemotherapy in patients with advanced-stage high-grade serous ovarian
carcinoma (HGSOC). Methods: MAGE-A10 and NY-ESO-1 protein
expression was analyzed by immunohistochemistry (IHC) in formalin-fixed,
paraffin-embedded samples from 93 patients with advanced-stage HGSOC
treated at our institutions between January 1996 and December 2013.
Correlation between expression of these markers and response to
platinum-based chemotherapy, evaluated according to RECIST 1.1 criteria,
platinum sensitivity, measured as platinum free interval (PFI),
progression free (PFS) and overall survival (OS) was explored.
Results: MAGE-A10 protein expression predicts
unresponsiveness to platinum-based chemotherapy ( p=0.005), poor
platinum sensitivity ( p<0.001), and poor PFS (
p<0.001) and OS ( p<0.001).
Multivariate analysis identifies MAGE-A10 protein expression as
independent predictor of poor platinum sensitivity ( p=0.005) and
shorter OS ( p<0.001). Instead, no correlation was
observed between NY-ESO-1 protein expression and response to
platinum-based chemotherapy (p=0.832), platinum sensitivity (p= 0.168),
PFS (p=0.126) and OS (p=0.335). Conclusion:
MAGE-A10 protein expression reliably identifies advanced-stage HGSOC
unresponsive to platinum-based chemotherapy. Targeted immunotherapy
could represent an important alternative therapeutic option in these
cancers.
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