Endometrial cancer arising after complete remission of uterine malignant lymphoma: A case report and mutation analysis

Abstract

Uterine malignant lymphoma is rare and its association with secondary cancer has not been fully described. Here, we report a rare case of endometrial cancer arising after 1 year of complete remission of uterine diffuse large B-cell lymphoma (DLBCL). An 88-year-old woman was referred to us for abnormal genital bleeding and was diagnosed with uterine DLBCL. She underwent chemotherapy comprising rituximab with cyclophosphamide, doxorubicin, vincristine, and prednisolone followed by radiation therapy; subsequently, she achieved complete remission. One year later, she noticed genital bleeding recurrence, and endometrial biopsy revealed endometrial adenocarcinoma. Total hysterectomy and bilateral salpingo-oophorectomy were performed. Her pathological diagnosis was endometrial endometrioid carcinoma, grade 1 (pT1aN0). Adenocarcinoma was observed over foamy macrophages aggregates, indicating remission of DLBCL. Targeted sequencing of both DLBCL and endometrial cancer revealed 24 gene mutations including the truncation-type mutations of ARID1A and PTEN occurring only in endometrial cancer. These multiple somatic gene mutations accumulating within 1 year imply endometrial carcinogenesis induced by DNA damages caused by treatment for DLBCL. Although the epidemiological risk of secondary malignancies after uterine lymphoma remains unclear, the present case serves as a warning for secondary cancer and highlights the importance of early detection and treatment.

Disparities in medical recommendations from AI-based chatbots across different countries/regions

“…1). The patient case scenarios were publicly available published data [12][13][14][15][16][17] and then adapted into vignettes and prompts. This step is processed into a question by adding a command sentence and a structured writing system.…”

Applying prednisone after radioactive iodine is helpful to reduce gastrointestinal reactions for papillary thyroid carcinoma patients

“…(3) no distant metastases found before initial 131 I therapy. Key exclusion criteria included (1) large thyroid remnant (the maximum diameter of remnant tissue was more than 2 cm evaluated by ultrasound right before RAI); (2) use of radioiodine or any immunomodulatory within the past 3 months; (3) previous adverse event associated with, or contraindication to prednisone; (4) women planning pregnancy within 1 year; (5) lactation; (6) pathological type was medullary carcinoma and follicular carcinoma; (7) inadequate follow-up information; (8) interfering antithyroglobulin antibody (TgAb) (> 46 IU/ml)(9); (9) white cell count below the local laboratory's reference range; (11) lymphocyte count < 0.8 * 10 9 /L; (12) abnormal renal function (estimated Glomerular Filtration Rate < 60 ml/min/1.73 m 2 ); (13) Abnormal liver function: bilirubin, alanine aminotransferase or alkaline phosphatase concentrations > 2 times more than the local laboratory's reference range; (13) concurrent use of other immunosuppressive agents. Finally, total 220 patients including 127 patients in prednisone treatment group and 93 patients in control group were incorporated.…”

“…Low dose prednisone is widely used after radiotherapy to prevent unwanted side-effects when treating leukemia(4), prostate cancer (5), non-small cell lung cancer(6), endometrial cancer (7) and so on. Guidelines for radioiodine therapy of differentiated thyroid cancer of China (2021 edition)(8) recommended applying prednisone to prevent and control adverse reaction due to RAI.…”