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Endometrial carcinoma is one of the most common female cancers in developed countries. Disease stage is associated with the risk of disease relapse after radical treatment. Typically, the risk of disease relapse peaks at 3 years from local radical treatment and then diminishes over time, so that late relapses (i.e., from year 5 afterward) are extremely infrequent. Here, we report two cases of women with endometrial cancer who developed a disease relapse more than 15 years after radical treatment. A review of the literature revealed other seven reports of women with relapse from endometrial cancer occurring more than 10 years after radical treatment. Although guidelines do not support oncological follow-up beyond 5 years from surgery, oncologists should consider late recurrence of endometrial carcinoma in the differential diagnosis of women presenting with metastases of uncertain origin and prior history of this disease.

Although adrenocortical carcinoma (ACC) during pregnancy is rare, a retrospective review of a case series at our hospital revealed that almost one third of our patients were women in childbearing age. Given that the age of maternity is increasing, dealing with a tumor diagnosis during pregnancy and the need for fertility planning in cancer survivors is likely to become more frequent.We thus carried out a case-based discussion regarding: i) diagnosing and treating an ACC during pregnancy; ii) patients conceiving while on mitotane; iii) ACC survivors with a maternal desire.In each of these cases, it is important to provide patients with sufficient information, to offer medical advice and psychological support, to personalize treatments in accordance with the wishes of the patient and her relatives, and to collaborate with other specialists since a multidisciplinary expert team is required to manage each case individually.

We report a case of a 37-year-old man with metastatic differentiated thyroid carcinoma, previously submitted to total thyroidectomy, radio-iodine therapy and lung metastasectomy, who underwent systemic treatment with lenvatinib for tumor recurrence in the lung, mediastinal lymph nodes, left gluteus and left orbit. Lenvatinib induced rapid and durable disease regression; the drug effect has continued after >1 year, as well as a very considerable clinical benefit. The results achieved by lenvatinib in treatment of metastatic differentiated thyroid carcinoma are clear and irrefutable. Real-life data, obtained by case reports and retrospective studies, are equally important to increase the knowledge about this drug and improve the clinical management.

In this large international study of patients with adrenal cancer, a rare, treatment-refractory disease, mitotane plus a combination of etoposide, cisplatin, and doxorubicin had greater antitumor activity than mitotane plus streptozotocin. Adrenocortical carcinoma is a rare cancer (estimated incidence, 0.7 to 2.0 cases per 1 million population per year) 1 , 2 with a poor prognosis; the 5-year survival rate is less than 15% among patients with metastatic disease. 3 – 7 Mitotane is the only drug approved for the treatment of adrenocortical carcinoma and is used both as adjuvant therapy and for advanced disease, 8 – 14 although its efficacy has never been shown in a randomized trial. The experience with other antineoplastic drugs for the treatment of this disease is even more limited. Current treatment strategies for advanced disease are based exclusively on retrospective series . . .

This retrospective analysis assessed the efficacy of adjuvant mitotane treatment in prolonging recurrence-free survival in adrenocortical cancer, which carries a high risk of recurrence. Survival was significantly prolonged in patients receiving mitotane, as compared with those who did not. Adjuvant mitotane may prolong recurrence-free survival in patients with radically resected adrenocortical carcinoma. This retrospective analysis assessed the efficacy of adjuvant mitotane treatment in prolonging recurrence-free survival in adrenocortical cancer. Survival was significantly prolonged in patients receiving mitotane, as compared with those who did not. Adrenocortical carcinoma is a rare neoplasm characterized by a dismal prognosis, with only 16 to 38% of patients surviving for more than 5 years after diagnosis. 1 – 3 Although a majority of patients have resectable disease at presentation, 4 – 6 as many as 75 to 85% have a relapse after radical resection. 7 , 8 This high recurrence rate has prompted investigators to consider the use of adjuvant therapy, 1 – 3 , 9 and mitotane (a synthetic derivative of the insecticide dichlorodiphenyltrichloroethane [DDT]) has been widely used for this purpose. 10 – 21 However, available studies do not provide data as to whether adjuvant mitotane is efficacious, mainly . . .

The differential diagnosis of adrenocortical carcinoma from adrenocortical adenoma is based on different pathological parameters, usually incorporated in scoring systems, which unfortunately lack a 100% sensitivity and specificity. Little is known on the molecular mechanisms leading to the malignant phenotype in adrenocortical tumors. Among other molecules, metalloproteinases were demonstrated to be implicated in malignant progression and metastatization of solid tumors, including endocrine ones. Therefore, we aimed to investigate metalloproteinases and their inhibitors expression in a series of 50 adrenocortical carcinomas and 50 control adrenocortical adenomas, diagnosed according to the Weiss histological criteria. Immunohistochemical results were scored by semiquantitative analysis and compared with clinicopathological parameters and outcome. Metalloproteinase type 2 gave the most significant result, being detected in neoplastic cells in 1/50 adrenocortical adenomas (2%) and 37/50 adrenocortical carcinomas (74%) (P<0.001), with a focal (score 1, <20% of positive cells—two-thirds of cases) or diffuse (score 2, >20% of positive cells—one-third of cases) pattern. In addition, diffuse (score 2) metalloproteinase type 2 protein expression, as compared to focal or negative immunostaining, correlated with shorter survival (P<0.02) and disease-free interval (P=0.05). No correlation was found comparing metalloproteinase type 2 expression and any clinicopathological parameter. Our data indicate that metalloproteinase type 2 immunohistochemical localization in tumor cells is significantly restricted to malignant adrenocortical tumors, with high specificity but low sensitivity. In addition, a strong metalloproteinase type 2 expression in adrenocortical carcinoma was for the first time recognized as an unfavorable prognostic factor.

Liposomal chemotherapeutic drugs have distinctive pharmacokinetics and different toxic-effect profiles compared with freely delivered substances.3 Pegylated liposomal doxorubicin, a formulation of doxorubicin in long-circulating, polyethylene(glycol)-coated liposomes, is currently approved for use in AIDS-related Kaposi's sarcoma, platinum-refractory ovarian cancer, and metastatic breast cancer.3,4 Evidence from preclinical and clinical data suggests that pegylated liposomal doxorubicin accumulates preferentially in tissues with increased microvascular permeability because of the leaky vasculature, which exists for most tumours with active neoangiogenesis.5 Unfortunately, stealth liposomes also accumulate in healthy and susceptible tissues, including the skin and the mucosa. Patients who develop PPE have erythema and oedema of the skin that can lead to blistering desquamation.6,7 PPE might have developed because the small size (100 nm in diameter) and long circulation time (half-life of about 48 h) of pegylated liposomes allow doxorubicin to accumulate in regions of skin that are highly vascularised by small capillaries, causing tissue damage, especially in sites most subjected to pressure, friction, and microtraumatisation. [...]any activity that could increase the risk of skin damage and augment blood flow to the skin should be avoided during treatment.4 Extravasation has been estimated to take place in 0·5–6·00% of patients receiving chemotherapy.1 Non-pegylated doxorubicin extravasation could lead to necrosis of the skin and soft tissues, which often needs surgical reconstruction of the destroyed tissue. [...]recall skin toxic effects after the use of pegylated liposomal doxorubicin in a site of previous extravasation is a new type of skin toxic effect of this drug.