A very rare presentation of lung cancer: Metastases to the distal phalanx of index-case report.

RATIONALE: Acrometastases of the hand are an unusual sign of lung cancer onset and may often be mistaken for other benign disorders, thus delaying diagnosis and treatment. PATIENT CONCERNS: A 58-year-old man presented at the Rheumatology Clinic with a lump in the distal phalanx of the right index finger associated with intense pain, swelling, rib pain, and hemoptysis. DIAGNOSES: Given the clinical manifestations, an x-ray of the right hand was performed, and it revealed an osteolytic lesion in the distal phalanx of the right index finger. The subsequent CT of the thorax and abdomen showed a lung tumor, osteolytic lesions in the ribs, sternum, and the thoracic spine. INTERVENTIONS: Amputation of the phalanx was decided on account of intense pain refractory to NSAIDs and opioids. Pathology assessment established the diagnosis of bone metastases secondary to lung adenocarcinoma. The patient underwent 6 cycles of first-line palliative chemotherapy with cisplatin and gemcitabine with partial response according to the RECIST 1.1. criteria. EGFR and ALK testing were not available at the time. A year later, the patient presented with progressive disease, which lead to 6 more cycles of chemotherapy with docetaxel. The disease progressed during chemotherapy and the patient was switched to erlotinib. OUTCOMES: After 7 months of anti-EGFR treatment, the patient passed away due to disease progression, thus having an overall survival of 25 months. LESSONS: On rare occasions, acrometastases of the hand may be the first manifestation of a lung cancer and, as such, they must be taken into consideration in the differential diagnosis of rheumatologic disorders. They are a poor prognosis marker, but some cases like this one can have a better survival than reported in the literature, most likely due to that particular cancer's biology.

KRAS, NRAS, BRAF, HER2 and microsatellite instability in metastatic colorectal cancer - practical implications for the clinician.

Background Colorectal cancer is a successful model of genetic biomarker development in oncology. Currently, several predictive or prognostic genetic alterations have been identified and are used in clinical practice. The RAS gene family, which includes KRAS and NRAS act as predictors for anti-epithelial growth factor receptor treatment (anti-EGFR), and it has been suggested that NRAS mutations also play a role in prognosis: patients harboring NRAS alterations have a significantly shorter survival compared to those with wild type tumours. BRAF V600E mutations are rare and occur mostly in tumors located in the ascending colon in elderly female patients. BRAF is instrumental in establishing prognosis: survival is shorter by 10-16 months in BRAF-mutant patients, and BRAF may be a negative prognostic factor for patients who undergo hepatic or pulmonary metastasectomy. Moreover, this mutation is used as a negative predictive factor for anti-EGFR therapies. Two new biomarkers have recently been added to the metastatic colorectal cancer panel: HER2 and microsatellite instability. While HER2 is still being investigated in different prospective studies in order to validate its prognostic role, microsatellite instability already guides clinical decisions in substituted with advanced colorectal cancer. Conclusions There are current evidences that support using above mentioned genetic biomarkers to better identify the right medicine that is supposed to be used in the right patient. This approach contributes to a more individualized patient-oriented treatment in daily clinical practice.

Importance of Psychological Intervention in the Management of a Patient With Non-Hodgkin Lymphoma and Stage C3 AIDS Disease.

Long-term evolution of HIV because of noncompliance and nonadherence to antiretroviral therapy favors the occurrence of difficult to treat HIV-related malignancies. We present the case of a female patient in "the pediatric cohort" registered at the Iasi Regional HIV/AIDS Center since year 2000, now with stage C3 AIDS. In 2014, a Burkitt lymphoma was pathologically confirmed, and chemotherapy was initiated as recommended by the hematologist. The clinical course was characterized by multiple complications: hematologic and hepatic toxicities, opportunistic infections and depressive episodes. Highly active antiretroviral therapy associated with sustained psychological support resulted in stabilization of the patient's clinical course (lower HIV viral load and higher CD4 lymphocyte cell counts), anticancer therapy being better tolerated. Currently, patient's clinical-biological status is quasi-normal. The depressive episodes in this HIV-positive cancer patient undergoing chemotherapy contributed to her non-adherence and non-compliance to treatment, with serious consequences both on clinical and viroimmunological status. Therapeutic strategy in this patient with AIDS and Burkitt lymphoma raised management difficulties as both the drug interactions and cumulative adverse effects had to be considered. Multidisciplinary collaboration and especially psychological intervention are essential for creating a functional team, effective communication being key to achieving long-term adherence to treatment and diagnosis acceptance.