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BACKGROUND: Pituitary metastasis of lung cancer is rare; however, it often causes diabetes insipidus. Although the majority of such patients are treated with radiation therapy, it remains unclear whether diabetes insipidus can be controlled by radiation therapy. CASE: A 72-year-old man was admitted to our hospital for hemosputum, headache, and polyuria. A chest CT scan showed a 3.0 cm mass in the left upper lobe of his lung. Bronchofiberscopy results confirmed the pathological diagnosis of lung adenocarcinoma. Based on the findings from PET-CT, head MRI, and endocrine tests, the diagnosis of lung adenocarcinoma( cT1bN0M1b, stage IV)accompanied with central diabetes insipidus caused by pituitary metastasis was made. Oral administration of desmopressin reduced urine volumes; however, chemotherapy for achieving stable disease in the primary tumor was ineffective in controlling the symptoms of diabetes insipidus. Chemotherapy was discontinued after 4 months because of severe hematological toxicity. During 2 months after the cessation of chemotherapy, polyuria worsened and, therefore, radiation therapy for pituitary metastasis was started. Following the radiation therapy, an apparent reduction in urine volume was observed. CONCLUSION: Our experience of this case suggests that radiation therapy for pituitary metastasis should be considered at the time when diabetes insipidus becomes clinically overt.
Assuntos
Adenocarcinoma/radioterapia , Diabetes Insípido Neurogênico/etiologia , Neoplasias Pulmonares/radioterapia , Neoplasias Hipofisárias/radioterapia , Adenocarcinoma de Pulmão , Idoso , Humanos , Imageamento por Ressonância Magnética , Masculino , Neoplasias Hipofisárias/diagnóstico por imagem , Neoplasias Hipofisárias/secundárioAssuntos
Anticorpos Monoclonais/efeitos adversos , Antineoplásicos Imunológicos/efeitos adversos , Carcinoma de Células Escamosas/tratamento farmacológico , Pneumonia em Organização Criptogênica/induzido quimicamente , Neoplasias Pulmonares/tratamento farmacológico , Corticosteroides/uso terapêutico , Idoso , Broncoscopia , Carcinoma de Células Escamosas/patologia , Quimiorradioterapia , Pneumonia em Organização Criptogênica/diagnóstico por imagem , Pneumonia em Organização Criptogênica/tratamento farmacológico , Pneumonia em Organização Criptogênica/patologia , Humanos , Neoplasias Pulmonares/patologia , Quimioterapia de Manutenção , Masculino , Estadiamento de Neoplasias , Tomografia Computadorizada por Raios XAssuntos
Antirreumáticos , Artrite Reumatoide , Meningite Criptocócica , Abatacepte/efeitos adversos , Antirreumáticos/efeitos adversos , Artrite Reumatoide/tratamento farmacológico , Humanos , Meningite Criptocócica/induzido quimicamente , Meningite Criptocócica/diagnóstico , Meningite Criptocócica/tratamento farmacológico , Resultado do TratamentoRESUMO
Atezolizumab is an immune checkpoint inhibitor that is a key drug in non-small-cell lung cancer treatment. However, it can cause immune-related adverse events, including liver injury. Several patterns of liver injury associated with immune checkpoint inhibitor therapy have been reported; however, not much is known about sclerosing cholangitis. We present here a case of lung adenocarcinoma with atezolizumab-induced secondary sclerosing cholangitis diagnosed using needle biopsy of the liver. A 77-year-old woman with lung adenocarcinoma, cT3N2M0, stage IIIA, was treated with concurrent chemoradiotherapy involving carboplatin and paclitaxel, which markedly reduced the tumor diameter. However, 5 months later, the lesion regrew, and she underwent 39 cycles of pemetrexed monotherapy. As pulmonary metastasis progressed, she was treated with atezolizumab. After 13 cycles of atezolizumab therapy, she complained of nausea. Laboratory tests showed elevated levels of the biliary tract and hepatic enzymes. Nevertheless, abdominal computed tomography and ultrasonography revealed no underlying related cause. Ultrasound-guided needle biopsy of the liver was performed, and histopathological analysis of biopsy samples showed features of sclerosing cholangitis. Further examinations were performed, and a diagnosis of atezolizumab-induced secondary sclerosing cholangitis without strictures and dilatations of the large bile ducts was established. Prednisolone was administered orally, after which the biliary tract and hepatic enzyme levels improved immediately. In patients presenting with a hepatic injury during immune checkpoint inhibitor therapy, clinicians should be aware of the possibility of immune checkpoint inhibitor-induced sclerosing cholangitis, even if the large bile ducts have no strictures and dilatations.
Assuntos
Adenocarcinoma de Pulmão/tratamento farmacológico , Anticorpos Monoclonais Humanizados/efeitos adversos , Colangite Esclerosante/imunologia , Inibidores de Checkpoint Imunológico/efeitos adversos , Neoplasias Pulmonares/tratamento farmacológico , Administração Oral , Idoso , Ductos Biliares/imunologia , Ductos Biliares/patologia , Colangite Esclerosante/induzido quimicamente , Colangite Esclerosante/diagnóstico , Colangite Esclerosante/tratamento farmacológico , Feminino , Humanos , Neoplasias Pulmonares/diagnóstico , Prednisolona/administração & dosagem , Resultado do TratamentoRESUMO
Multiple patchy pulmonary consolidations that are unresponsive to antibiotics and/or exist at peri-bronchial sites and bloody bronchoalveolar lavage may effectively help clinicians diagnose granulomatosis with polyangiitis.
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Chest computed tomography image of a 23-year-old man. Image shows right-sided middle and lower lobe consolidation and multiple cystic bronchiectasis.
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