Gestational trophoblastic diseases comprise a rare spectrum of disorders in which the normal regulatory mechanisms controlling the behaviour of trophoblastic tissue are lost. They vary from the ...benign complete and partial hydatidiform moles to the frankly malignant choriocarcinoma and placental site trophoblastic tumours. The majority will be cured by suction curettage, followed by human chorionic gonadotrophin screening, but some will go on to need chemotherapy. The majority of patients will be cured even despite the presence of metastatic disease. Patients should have their treatment stratified according to various prognostic factors in order to ensure firstly their disease is eliminated and secondly to reduce the incidence of long-term treatment complications.
A 71-year-old patient receiving combination chemotherapy (irinotecan, oxaliplatin and 5-fluorouracil (5-FU)) for metastatic pancreas cancer was admitted after her first cycle of chemotherapy with a ...severe and unexpectedly prolonged episode of neutropenic sepsis associated with pancytopenia and marked mucositis. Owing to the unusual picture, the patient was tested for mutations in the gene encoding the enzyme dihydropyrimidine dehydrogenase (DPD)—an enzyme involved in the metabolism of the chemotherapy drug 5-FU. The patient was found to be heterozygous for a mutation, DPD IVS14+1G>A, leading to the severe toxicity exhibited following this regimen caused by delayed metabolism of 5-FU. She was treated aggressively with supportive care and recovered from this episode. Importantly she was subsequently switched to an alternative chemotherapy regimen to treat her disease. She continues to maintain an excellent quality of life some 9 months after her initial diagnosis on third-line chemotherapy.
Systemic lupus erythematosus (SLE) is known as the ‘great imitator’ mimicking a myriad of conditions often resulting in a delayed diagnosis. We report a case with multisite adenopathy radiologically ...suggestive of lymphoma who initially was referred to the ‘Cancer of Unknown Primary’ team. Following a re-evaluation of the case the patient was diagnosed with SLE and was started on appropriate therapy. Many conditions presenting to oncology may mimic cancer which needs to be borne in mind when assessing referred cases.
PDF
