RESUMEN
ABSTRACT: We report the case of a 72-year-old man with bilateral testicular involvement by mycosis fungoides (MF). The patient was diagnosed with MF 6 months prior, and testicular involvement was found upon staging. The rare behavior of MF, with early visceral involvement and no hematolymphoid organs affected, had a poor prognosis with patient death 14 months after the original diagnosis despite surgery and chemotherapy. The neoplastic cells showed a phenotypic switch from a CD4 + /CD8 - profile in the skin to a CD4 - /CD8 - in the testis and the same clone, confirmed with T-cell receptor gene rearrangement studies, making this the third reported case of MF affecting the testis and the first with clonality studies to confirm it. The clinical evolution may be related to its distinctive biology showcased in the neoplastic cell's switch to a more aggressive CD4 - /CD8 - profile and the early extension of the disease to an uncommon visceral site.
Asunto(s)
Micosis Fungoide , Fenotipo , Neoplasias Cutáneas , Neoplasias Testiculares , Humanos , Masculino , Micosis Fungoide/patología , Micosis Fungoide/genética , Anciano , Neoplasias Testiculares/patología , Neoplasias Testiculares/genética , Neoplasias Cutáneas/patología , Neoplasias Cutáneas/genética , Resultado Fatal , Neoplasias de las Glándulas Salivales/patología , Neoplasias de las Glándulas Salivales/genética , Biomarcadores de Tumor/análisis , Biomarcadores de Tumor/genética , Reordenamiento Génico de Linfocito T , InmunofenotipificaciónRESUMEN
Multiple myeloma (MM) is a very heterogeneous disease with multiple symptoms and clinical manifestations. MM affects mainly elderly patients and is difficult to manage in the presence of comorbidities, polypharmacy, frailty and adverse events of disease-targeted drugs. The rapid changes in MM treatment resulting from constant innovations in this area, together with the introduction of numerous new drugs with distinct mechanisms of action and toxicity profiles, have led to an increased complexity in the therapeutic decision-making and patient management processes. The prolonged exposure to novel agents, sometimes in combination with conventional therapies, makes this management even more challenging. A careful balance between treatment efficacy and its tolerability should be considered for every patient. During treatment, a close monitoring of comorbidities, disease-related manifestations and treatment side effects is recommended, as well as a proactive approach, with reinforcement of information and patient awareness for the early recognition of adverse events, allowing prompt therapeutic adjustments. In this review, we discuss various issues that must be considered in the treatment of MM patients, while giving practical guidance for monitoring, prevention and management of myeloma-related manifestations and treatment-related toxicities.