Bleomycin has been used most commonly in the treatment of Hodgkin’s lymphoma, certain germ cell tumors (GCT) and for the sclerosis of recurrent pleural effusions. Bleomycin toxicity predominantly affects the skin and lungs. Skin toxicity includes Raynaud’s phenomenon, hyperkeratosis, nail-bed changes and palmoplantar desquamation. Flagellate erythema is an unusual rash occurring specifically during bleomycin use. In the present study, we report a case of bleomycin-induced flagellate erythema in a patient with GCT. A 42-year-old male was diagnosed with stage IIIB testicular cancer and treated with bleomycin, etoposide and cisplatin chemotherapy. After 10 days from the initiation of treatment, the patient subsequently developed a generalized pruritus and erythematous linear rash that was most prominent on the trunk, and upper and lower extremities. The patient was commenced on a short course of low-dose oral prednisolone, 20 mg daily, and antihistamine. Consequently, bleomycin was withheld from the patient’s treatment regimen. The present study describes the case, along with a review of the associated literature.
I n t r o d u c t i o nPancreatic cancer was Korea's fifth leading cause of cancerrelated deaths in 2006 and almost all the pancreatic cancer patients were expected to die from the disease (1). The development of better imaging techniques has allowed more pancreatic tumors to be recognized and diagnosed. Pancreatic neoplasms and malignancies arise from both the endocrine and exocrine portions of the organ. More than 90% of the malignant tumors of the pancreas arise from the exocrine elements of the gland (ductal and acinar cells), and these tumors demonstrate features that are consistent with adenocarcinoma. The World Health Organization (WHO) recognizes several histomorphologic variants of ductal adenocarcinoma, including mucinous noncystic carcinoma, signet ring carcinoma, adenosquamous carcinoma, undifferentiated (anaplastic) carcinoma, undifferentiated carcinoma with osteoclastlike giant cells and mixed ductal-endocrine carcinoma. The WHO currently recognizes clear cell carcinoma as a "miscellaneous" carcinoma of the pancreas, and this tumor is characteristically rich in glycogen and poor in mucin (2). Unfortunately, not much data is available on this clear cell tumor. The incidence and prognosis are not well known and only a few such cases have been reported in the literature. Moreover, there has been no previous report of primary clear cell carcinoma of the pancreas in Korea. Herein, we report on a unique case of primary clear cell carcinoma of the pancreas and we include the pathologic description of this tumor. Most of the malignant neoplasms of the pancreas demonstrate features that are consistent with adenocarcinoma. According to the WHO classification, primary clear cell carcinoma of the pancreas is rare and it is classified as a "miscellaneous" carcinoma. In addition, there is not an adequate systematic overview that can demonstrate its true existence as a definable entity. We report here on an unusual case of primary pancreatic clear cell carcinoma, which is the first such reported case in Korea. A 66 year old woman presented with abdominal pain and significant weight loss over the previous three weeks. On the abdominal computed tomography (CT), we detected an abdominal mass involving the pancreas tail and liver, and clear cell carcinoma with rhabdoid feature was seen on the histologic evaluation. The tumor cells showed well defined cell membranes, clear cytoplasm and prominent cell boundaries. The immunohistochemical stains showed positive reactions to antibodies against pancytokeratin, cytokeratin 7, carcinoembryonic antigen (CEA) and epithelial membrane antigen (EMA). On the other hand, there was a negative reaction for cytokeratin 20, chromogranin, synaptophysin, smooth muscle actin and HMB-45. She was diagnosed with a primary pancreatic clear cell carcinoma with hepatic metastasis and she received palliative gemcitabine chemotherapy. The patient died one month later of pancreatic cancer progression.
Pemetrexed is approved as a first-line treatment for advanced non-squamous non-small cell lung cancer (NSCLC) with cisplatin and as a single agent for second-line treatment or for patients who show no disease progression after four cycles of platinum-based doublet induction chemotherapy as maintenance therapy. Pemetrexed has a modest toxicity profile and has not traditionally been regarded as a cause of interstitial pneumonitis. Here, we report on a rare case of pemetrexed-induced pneumonitis in a patient with NSCLC.
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