[Mediastinal germ-cell tumours]. / Tumores germinales mediastínicos.

Germ-cell tumours of male ussually arise from the testis. However, in 2-5% of the cases, they also occur outside of the testis as a primary site without evidence of testicular primary tumour. This infrequent entity often appears in the body midline, predominantly in mediastinum and retroperitoneum. Mediastinal germ-cell tumours (MGCT) shall be included in the differential diagnosis of any mediastinic tumour of unknown origin. An accurate diagnosis is essential, due to the fact that these tumours are curable with chemotherapy. The histopathologic and clinical features, and its differences with germ-cell tumours from testicular origin are revised in this article.

[Effectivity of cetuximab monotherapy in the treatment of refractory advanced cancer of the head and neck]. / Efectividad de Cetuximab en monoterapia en el tratamiento de cánceres de cabeza y cuello avanzado refractario.

INTRODUCTION: More than 90% of carcinoma of the head and neck (CHN) have an overexpression of the EGFR gene, and that overexpression is associated with a worse prognosis. Cetuximab is a monoclonal antibody against EGFR. PATIENTS AND METHODS: We have conducted a retrospective study of 10 consecutive cases with metastatic and/or recurrent CHN treated with cetuximab monotherapy as second line therapy, with the main objective of analyzing the progression-free survival (PFS); we also analyzed the response rate, the overall survival (OS), and toxicity profile as second end points. RESULTS: The median age was 55 years, and 100% of patients were males. Fourty percent of the patients received cetuximab as second line, and 60% as third line therapy. With a median follow-up of 13.5 months, the median PFS was 4 months (95%CI: 3.4-4.6 months), with a median OS of 9.7 months (95%CI: 2.9-16.6 months).The objective response rate was 10%, and the disease control rate was 60% (Partial response = 10% and stable disease for > 16 weeks = 50%). Thirty percent of patients had grade 3 rash. CONCLUSIONS: Cetuximab monotherapy has a modest effectivity in the treatment of refractory CHN, but with a limited toxicity. Future studies should use combinations of cetuximab with others effective chemotherapeutic drugs in the treatment of CHN, such as taxanes.

[Adrenal failure caused by primary adrenal non-Hodgkin lymphoma: a case report and review of the literature]. / Insuficiencia suprarrenal causada por un linfoma no-Hodgkin B primario suprarrenal: presentación de un caso y revisión de la literatura.

We report a case of 78-year old man who presented with symptoms of adrenal insufficiency. The computed tomography (CT) scan showed the presence of bilateral adrenal masses. A CT-scan guided needle biopsy revealed diffuse large- B cell lymphoma. The absence of pathological findings in clinical, bone marrow and CT scan examinations supported the diagnosis of primary non-Hodgkin Lymphoma of the adrenal glands. The patient was treated with four cycles of R-CHOP chemotherapy with Rituximab, liposomal Doxorubicin, Cyclophosphamide, Vincristine and Prednisolone. At the end of fourth cycle there was radiological improvement but the chemotherapy was stopped because of IV grade toxicity. He completed treatment with radiotherapy of right adrenal mass. Few days after finishing radiation therapy the patient died due to a disseminated infection. No progressive disease was founded.

Tumores germinales mediastínicos / Mediastinal germ-cell tumours

Los tumores de células germinales del varón habitualmente se originan en los testículos. Sin embargo, en el 2-5% de los casos pueden aparecer de forma primaria en localizaciones extragonadales, sin evidencia de un tumor testicular. Esta infrecuente entidad suele aparecer en la línea media corporal, predominántemente en el mediastino y en el retroperitoneo. Los tumores germinales extragonadales mediastínicos (TGEM) deben incluirse en el diagnóstico diferencial de cualquier tumor mediastínico de origen desconocido. Un diagnóstico exacto es fundamental, debido a que son tumores potencialmente curables con quimioterapia. En este artículo se revisan las características histopatológicas y clínicas de losTGEM, y sus diferencias los tumores germinales de origen testicular

Germ-cell tumours of male ussually arise from the testis. However, in 2-5% of the cases, they also occur outside of the testis as a primary site without evidence of testicular primary tumour. This infrequent entity often appears in the body midline, predominantly in mediastinum and retroperitoneum. Mediastinal germ-cell tumours (MGCT) shall be included in the differential diagnosis of any mediastinic tumour of unknown origin. An accurate diagnosis is essential, due to the fact that these tumours are curable with chemotherapy. The histopathologic and clinical features, and its differences with germ-cell tumours from testicular origin are revised in this article

[Adjuvant treatment of operable breast cancer]. / Tratamiento adyuvante en el cáncer de mama operable.

Breast cancer(BC) is the most frequent neoplasm in women of the west countries. The treatment of BC is very complex, and include the combination of surgery, chemotherapy, radiotherapy, hormone therapy and immunotherapy. Surgery is the gold standard in the radical treatment of BC. Anthracyclines and taxanes are very important in the adjuvant treatment of BC. These drugs have shown an increased disease-free-survival and overall survival in several studies. Tamoxifen has been the gold standard adjuvant hormone therapy for the treatment of postmenopausal women with hormone-receptor-positive early BC for many years, but the third-generation aromatase inhibitors (letrozole, anastrozole, and exemestane) are now recommended as the preferred therapy. Trastuzumab in combination with adjuvant chemotherapy has changed the natural history of early Her-2 positive BC. New drugs are under investigation in the treatment of BC.

[Efficiency of bortezomib and dexamethasone in relapsed multiple myeloma treatment: retrospective study in consecutive cases]. / Efectividad de bortezomib y dexametasona en el tratamiento de mieloma múltiple refractario: estudio retrospectivo de una serie de casos consecutivos.

INTRODUCTION: Multiple myeloma (MM) is a plasm-cell neoplasm, that is characterized by a monoclonal protein in the serum or urine. Bortezomib is an efficacy drug for the second line treatment of MM. PATIENTS AND METHOD: We conducted a retrospective study of 21 consecutive cases with refractory MM treated with bortezomib and dexamethasone as second line therapy, with the objective of analyzing the overall response rate (primary end point), the progression-free survival (PFS), the overall survival (OS), the duration of response (DR) and toxicity profile (second end points). RESULTS: In our study we found an overall response rate of 70%. With a median follow-up of 15 months, we had a median PFS of 12 months (95% CI: 2-21 months), with a median OS of 17 months (95% CI: 2-32 months), and a median DR of 9 months (95% CI: 5-13 months). Fourty-seven percent of patients had neuropathy, the 33% thrombocytopenia, 13.33% anemia and 26.66% diarrhea. CONCLUSIONS: The combination of bortezomib and dexamethasone is an effective and safe treatment in second line of refractory MM, with a manageable toxicity.

Efectividad de Cetuximab en monoterapia en el tratamiento de cánceres de cabeza y cuello avanzado refractario / Effectivity of cetuximab monotherpay in the treatment of refractory advanced cancer of the head and neck

Introducción: más del 90% de los cánceres de cabeza y cuello (CCC) presentan una sobreexpresión del gen EGFR, y dicha sobreexpresión se asocia a un peor pronóstico. Cetuximab es un anticuerpo monoclonal dirigido contra EGFR. Pacientes y métodos: hemos llevado a cabo un estudio retrospectivo de una serie de 10 casos consecutivos de CCC metastáticos y/o recurrentes a los que hemos tratado con cetuximab en monoterapia en segundas líneas de tratamiento, con el objetivo principal de analizar la supervivencialibre de progresión (SLP), así como la tasa de respuestas, la supervivencia global (SG) y la toxicidad como objetivos secundarios. Resultados: la mediana de edad fue de 55 años, y el 100% de los pacientes eran varones. El 40% de los pacientes recibió cetuximab en segunda línea, y el 60% en tercera línea de tratamiento. Con una mediana de seguimiento de 13,5 meses, la mediana de SLP fue de 4 meses (IC95%: 3,4-4,6 meses), y la mediana de SG de 9,7 meses (IC95%: 2,9-16,6 meses). La tasa de respuestas objetivas fue del 10%, y la tasa de beneficio clínico fue del 60% (Remisión parcial = 10% y estabilización >16 semanas = 50%). El 30% de los pacientes presentaron toxicidad cutánea grado 3.Conclusiones: cetuximab en monoterapia tiene una efectividad discreta en el tratamiento de CCC refractarios, pero con una toxicidad escasa.Los futuros estudios deberían de encaminarse hacia la combinación de cetuximab con otros agentes quimioterápicos eficaces en el tratamiento de CCC, como los taxanos

Introduction: More than 90% of carcinoma of the head and neck (CHN) have an over expression of the EGFR gene, and that over expressionis associated with a worse prognosis. Cetuximab is a monoclonal antibody against EGFR. Patients and methods: We have conducted a retrospective study of 10 consecutive cases with metastatic and/or recurrent CHN treated with cetuximab monotherapy as second line therapy, with the main objective of analyzing the progression-free survival (PFS); we also analyzed there sponse rate, the overall survival (OS), and toxicity profile as secondend points. Results: The median age was 55 years, and 100% of patients were males. Fourty percent of the patients received cetuximab as second line, and 60% as third line therapy. With a median follow-up of 13.5 months, the median PFS was 4 months (95%CI: 3.4-4.6 months), with a median OS of 9.7 months (95%CI: 2.9-16.6 months).The objective response rate was 10%, and the disease control rate was 60% (Partial response = 10% and stable disease for > 16 weeks = 50%). Thirty percent of patients had grade 3 rash. Conclusions: Cetuximab monotherapy has a modest effectivity in the treatment of refractory CHN, but with a limited toxicity. Future studies should use combinations of cetuximab with others effective chemotherapeutic drugs in the treatment of CHN, such as taxanes

Insuficiencia suprarrenal causada por un linfoma no-Hodgking B primario suprarrenal: presentación de un caso y revisión de la literatura / Adrenal failure caused by primary adrenal non-hodking lymphoma: a case report and review of the literature

Presentamos el caso de un varón de 78 años que ingresa por un cuadro de debut de insuficiencia suprarrenal. Se realizó un estudio TC que mostró masas suprarrenales bilaterales de hasta 10 cm. Se completó estudio con biopsia percutanea de masa suprarrenal y biopsia de médula ósea, siendo diagnosticado de Linfoma no Hodgkin B difuso de células grandes primario suprarrenal con afectación suprarrenal bilateral. El paciente fue tratado con quimioterapia según esquema R-CHOP (Rituximab, Ciclofosfamida, Doxorrubicina liposomal, Vincristina y Prednisona).Tras 4 ciclos de quimioterapia se objetivo una respuesta parcial radiológica. Se suspendió la quimioterapia por toxicidad grado IV, completándose el tratamiento con RT sobre masa suprarrenal derecha. El paciente falleció por cuadro séptico pocos días después de finalizar la radioterapia, sin objetivarse progresión de la enfermedad

We report a case of 78-year old man who presented with symptoms of adrenal insufficiency. The computed tomography (CT) scan showed the presence of bilateral adrenal masses. A CT-scan guided needle biopsy revealed diffuse large- B cell lymphoma. The absence of pathological findings in clinical bone marrow and CT scan examinations supported the diagnosis of Lymphoma of the adrenal glands.The patient was treated with four cycles of R-CHOP chemotherapy with Rituximab, liposomal Doxorubicin, Cyclophosphamide, Vincristine and Prednisolone. At the end of fourth cycle there was radiological improvement but the chemotherapy was stopped because of IV grade toxicity. He completed treatment with radiotherapy of right adrenal mass. Few days after finishing radiation therapy the pacient died due to a disseminated infection. No progressive disease was founded

Efectividad de bortezomib y dexametasona en el tratamiento de mieloma múltiple refractario: estudio retrospectivo de una serie de casos consecutivos / Efficiency of Bortemozib and dexamethasone in relapsed multiple myeloma treatment: retrospective study in consecutive cases

Introducción: El mieloma múltiple (MM) es una neoplasia de células plasmáticas, que se caracteriza por la presencia de una proteína monoclonal en suero u orina. Bortezomib es un fármaco eficaz en el tratamiento de segunda línea del MM. Pacientes y métodos: Hemos realizado un estudio retrospectivo de una serie de 21 casos consecutivos de MM refractario a los que hemos tratado con bortezomib y dexametasona en segundas líneas, con el objetivo de analizar la tasa de respuesta (objetivo primario), la supervivencia libre de progresión (SLP), la supervivencia global (SG), la duración de respuesta (DR) y la toxicidad (objetivos secundarios). Resultados: En nuestro estudio hemos encontrado una tasa de respuesta total de 70%. Con una mediana de seguimiento de 15 meses, hemos obtenido una mediana de SLP de 12 meses (IC95%: 2-21 meses), una mediana de SG de 17 meses (IC95%:2-32 meses) y una mediana de DR de 9 meses (IC95%: 5-13 meses). El 47 % de los pacientes presentaron neuropatía,el 33% trombocitopenia, 13,33% anemia, y 26,66% diarrea. Conclusiones: La combinación de bortezomib y dexametasona es un tratamiento efectivo y seguro en segundas líneas de MM refractario, con una toxicidad manejable

Introduction: Multiple myeloma (MM) is a plasm-cell neoplasm, thatis characterized by a monoclonal protein in the serum or urine. Bortezomib is an efficacy drug for the second line treatment of MM. Patients and method: We conducted a retrospective study of 21 consecutive cases with refractory MM treated with bortezomib and dexamethasone as second line therapy, with the objective of analyzing the overall response rate (primary end point), the progression-free survival (PFS), the overall survival (OS), the duration of response (DR) and toxicity profile (second end points). Results: In our study we found an overall response rate of 70%. With a median follow-up of 15 months, we had a median PFS of 12 months (95% CI: 2-21 months), with a median OS of 17 months (95% CI: 2-32 months), and a median DR of 9 months (95% CI: 5-13 months). Fourtyseven percent of patients had neuropathy, the 33% thrombocytopenia,13.33% anemia and 26.66% diarrhea. Conclusions: The combination of bortezomib and dexamethasone is an effective and safe treatment in second line of refractory MM, with amanageable toxicity

Tratamiento adyuvante en el cáncer de mama operable / Adjuvant treatment of operable breast cancer

El cáncer de mama (CM) es la neoplasia más frecuente en las mujeres de los países occidentales. El tratamiento del CM es muy complejo, e incluye la combinación de la cirugía, quimioterapia, radioterapia, hormonoterapia e inmunoterapia. La cirugía continúa siendo el “gold estándar”en el tratamiento radical de CM. Las antraciclinas y los taxanos son esenciales en el tratamiento adyuvante de CM. Estos fármacos han demostrado un incremento significativo de la supervivencia libre de enfermedad y global en múltiples estudios. El tamoxifeno ha sido el “gold estándar” en la hormonoterapia adyuvante de las mujeres posmenopáusicas con receptores hormonales positivos durante muchos años, pero los inhibidores de aromatasas de tercera generación (letrozol, anastrozol y exemestano) se han convertido en el tratamiento recomendado actualmente. Trastuzumab en combinación con la quimioterapia adyuvante ha modificado la historia natural del CM localizado Her-2 positivo. Nuevos fármacos están en investigación en el tratamiento del CM

Breast cancer (BC) is the most frequent neoplasm in women of the west countries. The treatment of BC is very complex, and include the combination of surgery, chemotherapy, radiotherapy, hormonetherapy and immunotherapy. Surgery is the gold standard in the radical treatment of BC. Anthracyclines and taxanes are very important in the adjuvant treatment of BC. These drugs have shown an increased disease free-survival and overall survival in several studies. Tamoxifen has been the gold standard adjuvant hormonetherapy for the treatment of postmenopausal women with hormone-receptor-positive early BC for many years, but the third-generation aromatase inhibitors (letrozole, anastrozole, and exemestane) are now recommended as the preferred therapy.Trastuzumab in combination with adjuvant chemotherapy has changed the natural history of early Her-2 positive BC. New drugs are underinvestigation in the treatment of BC

False-positive beta-human chorionic gonadotropin values in the follow-up of gestational trophoblastic disease.

Gestational trophoblastic disease consists of a pathological spectrum of entities from molar pregnancies, which are premalignant conditions, to malignant invasive choriocarcinoma. Serum Beta-human chorionic gonadotropin (hCG) levels are essential both in the diagnosis and in the follow-up. There are high rates of complete responses and long-term survivors, because of the excellent chemosensitivity of these tumours. After initial management, an increased level of Beta-hCG indicates persistent disease. However, in the absence of evidence of persistent disease, false-positive Beta-hCG values may be considered. We present here the case of a woman with a metastatic choriocarcinoma in complete response after chemotherapy, who developed later persistent false-positive values of Beta-hCG in the follow-up. Causes of false-positive Beta-hCG determinations are revised.

False-positive beta-human chorionic gonadotropin values in the follow-up of gestational trophoblastic disease

Gestational trophoblastic disease consists of a pathological spectrum of entities from molar pregnancies, which are premalignant conditions, to malignant invasive choriocarcinoma. Serum Beta-human chorionic gonadotropin (hCG) levels are essential both in the diagnosis and in the follow-up. There are high rates of complete responses and long-term survivors, because of the excellent chemosensitivity of these tumours. After initial management, an increased level of Beta-hCG indicates persistent disease. However, in the absence of evidence of persistent disease, false-positive Beta-hCG values may be considered. We present here the case of a woman with a metastatic choriocarcinoma in complete response after chemotherapy, who developed later persistent false-positive values of Beta-hCG in the follow-up. Causes of false-positive Beta-hCG determinations are revised (AU)

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Linfoma T angioinmunoblástico: caso clínico y revisión de la literatura / Angioimmunoblastic T-cell lymphoma: a case report and review of the literature

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