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S.Y. Choi



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    P2.24 - Poster Session 2 - Supportive Care (ID 157)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Supportive Care
    • Presentations: 1
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      P2.24-018 - Primary mediastinal Castleman' disease; Surgically curable anemia : A case report (ID 1268)

      09:30 - 09:30  |  Author(s): S.Y. Choi

      • Abstract

      Background
      Castleman’s disease, an uncommon disease that causes benign lymph node hyperplasia, must be distinguished from reactive lymph node hyperplasia and malignancies. Unicentric Castleman’s disease in patients with anemia is rarely described.

      Methods
      We describe the case of a 25-year-old woman with plasma cell type of unicentric Castleman’s disease presenting as iron deficiency anemia. We report the clinical course from the initial presentation to diagnosis and surgical cure and review the literature.

      Results
      Figure 1 A 25-year-old woman was referred with abnormal chest X-ray which was found during pre-employment screening. She had no other complaints, and her previous medical history was unremarkable, as was her family medical history. No fever, acute infectious symptoms and signs, or any other abnormalities were found in the physical examination. Normocytic anemia was found based on initial blood tests (hemoglobin 7.7 g/dl, mean corpuscular volume 88.9 fl, with normal white blood cells, red blood cell distribution width, liver renal functions, and electrolytes). Further laboratory examinations (ferritin 89.0 ng/ml; serum iron 23 mg/dl; and total iron binding capacity 206 mg/dl) demonstrated that she was iron deficient. Chest X-ray and chest CT scan confirmed a mass (6x4x4 cm) at right superior and mid-mediastinum (Fig. 1). PET/CT showed paratracheal mass shows inhomogeneously high FDG uptake. In suspicion of lymphoma, diagnostic thoracoscopic surgery was planned. However, intraoperative frozen section diagnosis of a specimen was benign. Thus, the mass was completely removed and diagnosis was consistent with unicentric plasma cell type Castleman’s disease. Three months after surgery, without any medical intervention, the laboratory data had recovered to normal range (hemoglobin 14.5 g/dl). She receives regular follow ups and no recurrence has been found for 4 years since surgery.

      Conclusion
      The surgical resection would appear to be the optimal treatment modality, and constitutional symptoms may be resolved. The prognosis following complete surgical resection appears to be good.

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    P3.13 - Poster Session 3 - SCLC (ID 202)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Medical Oncology
    • Presentations: 1
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      P3.13-004 - A multicenter phase II study of belotecan, a new camptothecin analogue, in elderly patients with previously untreated, extensive-stage small cell lung cancer (ID 1335)

      09:30 - 09:30  |  Author(s): S.Y. Choi

      • Abstract

      Background
      Belotecan is a new camptothecin analogue and a potent topoisomerase I inhibitor. The aim of this phase II study was to investigate the efficacy and toxicity of belotecan in previously untreated elderly patients with small cell lung cancer (SCLC).

      Methods
      A total of 26 patients, aged ≥65 years, with previously untreated, extensive-stage SCLC were enrolled in the study. Belotecan was administered by daily intravenous infusion at 0.5 mg/m[2]/day for 5 consecutive days every three weeks.

      Results
      The overall response rate and disease control rate of chemotherapy on an intention-to-treat basis were 35% and 54%, respectively. The median overall survival was 6.4 months, and the median time to progression was 2.8 months. The most common toxicity was hematologic. Grade 3 or 4 neutropenia occurred in 80.8% of patients, and grade 3 or 4 thrombocytopenia in 15.3%. Non-hematologic toxic effects of grade 3 or 4 were uncommon.

      Conclusion
      Belotecan had modest efficacy and well-tolerated toxicity in previously untreated, elderly SCLC patients. Single belotecan could be a promising treatment option, considering its lower toxicity in elderly patients who are unsuitable candidates for platinum plus etoposide chemotherapy.

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    P3.16 - Poster Session 3 - Other Thoracic Malignancies (ID 188)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Thymoma & Other Thoracic Malignancies
    • Presentations: 1
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      P3.16-001 - Late-developing tongue adenoid cystic carcinoma after pulmonary metastasectomy (ID 1550)

      09:30 - 09:30  |  Author(s): S.Y. Choi

      • Abstract

      Background
      Adenoid cystic carcinoma (ACC) is a malignant neoplasm that usually arises in the salivary glands, but can also occur in the breast, skin, uterine cervix, upper digestive tract, and lung. Primary pulmonary ACC accounts for less than 0.2% of all lung cancers, and only 10% of all primary pulmonary ACCs are peripheral in origin. To the best of our knowledge, peripheral pulmonary ACC detected prior to its appearance in the tongue has not been reported previously in the literature.

      Methods
      We report herein a case of peripheral ACC in the right lower lobe, which was followed 27 months later by tongue ACC.

      Results
      A 52-year-old woman was referred to our hospital for evaluation of an incidentally found right lower lobe lung mass. She had a history of hypertension and denied recent weight loss or smoking. Her initial laboratory findings were unremarkable, and the results of a pulmonary function test were normal. A chest computed tomography (CT) scan revealed a relatively well-circumscribed and enhanced mass involving the visceral pleura in the right lower lobe, and no mediastinal lymphadenopathy. The mass was biopsied under video-assisted thoracoscopic surgery, and an intraoperative pathologic diagnosis revealed malignant lung cancer. The patient underwent right lower lobectomy and mediastinal lymph node dissection. A histopathological examination disclosed ACC with a cribriform and tubular pattern; metastasis was not found in the dissected lymph nodes. For confirmation of a primary or metastatic tumor, an otolaryngologic examination and whole-body positron-emission tomography (PET) were performed after lobectomy. The patient was diagnosed with primary peripheral pulmonary ACC because of no evidence of salivary gland tumor or other metastasis; Neither radiotherapy nor chemotherapy was not performed after lobectomy. During follow-up, the patient was diagnosed and treated for transitional cell cancer of bladder. Recurrence of the bladder cancer was suspected at 27 months after the pulmonary operation, and a whole-body PET scan showed that an enlarged and increased uptake pattern of both parotid nodules without recurrence in the lung. The bladder nodule was benign and the parotid nodules disclosed ACC of the tongue with metastasis to the parotid lymph node. The otolaryngologist performed wide excision of the tongue cancer. The pathologic diagnosis was ACC of the tongue; identical to those of the resected right lower lobe lung mass taken 27 months previously. After 5 week-adjuvant chemo-radiation therapy, she remained in good health and with no detectable recurrence at the 7-months follow-up.

      Conclusion
      We have presented herein a case of ACC with unusual clinical behaviors that remain to be fully defined. Although ACC is characteristically slow growing and associated with late distant metastasis, our case showed the reverse presentation pattern: early recognition of a metastasis and late presentation of the primary site. Therefore, peripheral pulmonary ACC should be carefully followed and considered in relation to head and neck ACC, even after successful management.