Pembrolizumab is an immune checkpoint inhibitor that induces side effects called “immune‐related adverse events” (irAEs). Various types of organs are affected by irAEs, although reports of upper gastrointestinal disorders are rare. Here, we report a case of extensive inflammatory pathologies in the oesophagus, stomach, duodenum, and jejunum after the administration of pembrolizumab for non‐small cell lung cancer.
Ewing's sarcoma (ES)/primitive neuroectodermal tumors (PNETs) are highly malignant neoplasms that usually affect the bones and soft tissues in children and young adults. ES/PNET of the lung is very rare and is associated with a poor prognosis. We herein report a case of ES/PNET of the left lung in a 45-year-old man. He was treated with neoadjuvant chemotherapy and pneumonectomy, but unfortunately his disease recurred 1.5 months after surgery. He was started on pazopanib, which resulted in a five-month progression-free survival. To our knowledge, this is the first demonstration of pazopanib efficacy in ES/PNET of the lung.
Objective:
Histological verification of epithelioid cell granuloma is
important in diagnosing sarcoidosis; tissue sampling is a worldwide requirement. In 2006,
to reduce medical expenses and avoid invasive procedures, diagnostic criteria without
histological verification were permitted by the Japanese government. In 2015, new
diagnostic criteria, allowed clinical diagnoses based on only respiratory, ocular, and
cardiac systems with at least a two-system involvement, increasing the need to sample
tissue from clinically unevaluable organs in suspected sarcoidosis. This study aimed to
compare the characteristics of patients who were diagnosed with sarcoidosis according to
the 2006 and 2015 criteria.
Materials and Methods:
Using the 2015 version, we re-evaluated the
characteristics of 264 patients with diagnosed or suspected sarcoidosis according to the
2006 criteria, at Jichi Medical University Hospital between 2004 and 2012 (clinical
diagnosis, 84; histological diagnosis, 117; suspected sarcoidosis 63).
Results:
Thirty-nine patients were diagnosed with suspected sarcoidosis due
to the absence of at least a two-system involvement; two patients had insufficient
laboratory data suggestive of sarcoidosis. Six patients moved from suspected sarcoidosis
to a histological diagnosis because of a greater leniency in the criteria for supportive
findings. The 2015 diagnostic criteria excluded patients with organ involvement without a
requirement for systemic steroids from the clinical diagnosis group. A case of schwannoma,
erroneously placed in the clinical diagnosis group by the 2006 criteria, was reclassified
according to the 2015 criteria.
Conclusion:
The 2015 version is preferable for clinically diagnosing
sarcoidosis, even without histological specimens, and provides guidance for indications
for systemic treatment.
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