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Mariana Ribeiro Monteiro



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    EP1.15 - Thymoma/Other Thoracic Malignancies (ID 205)

    • Event: WCLC 2019
    • Type: E-Poster Viewing in the Exhibit Hall
    • Track: Thymoma/Other Thoracic Malignancies
    • Presentations: 1
    • Now Available
    • Moderators:
    • Coordinates: 9/08/2019, 08:00 - 18:00, Exhibit Hall
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      EP1.15-25 - A Rare Case of Metastatic Leiomyoma of the Lung (Now Available) (ID 1996)

      08:00 - 18:00  |  Author(s): Mariana Ribeiro Monteiro

      • Abstract
      • Slides

      Background

      Leiomyoma is the most common benign uterine tumor. Atypically, it can show with metastatic disease. Lungs are the most frequent metastatic site. Although the benign, metastatic leiomyoma (MLM) has an indolent growth pattern and it may induce pulmonary symptoms and decrease the quality of life.

      Method

      We present a case of a 63-year-old woman, former smoker with a past medical history of hysterectomy and bilateral salpingo-oophorectomy due to leiomyoma in 1994.

      In 2015, the patient showed with a dry cough, chest pain and no fever. Chest X-ray revealed multiple non-specific bilateral pulmonary nodules. Chest and total abdominal CT scans were performed for further evaluation, which confirmed multiple well-circumscribed bilateral pulmonary nodules measuring up to 26mm and 31mm in the right and left lung respectively. No other suspected neoplastic lesions were found. Afterward, she underwent a thoracoscopic resection and pathology determined the neoplastic proliferation of smooth cells favoring the diagnosis of MLM. Tumor markers, including CEA, CA 19.9, CA 125, CA 15.3 and AFP were regular.

      Patient's symptoms have improved, and she has started a clinical follow-up alternating chest X-ray with chest CT scan every six months. Four years later, lung nodules have increased, measuring up to 37mm (Figure 1). She underwent a lung CT scan-guided biopsy and final pathology showed mesenchymal neoplasia of smooth muscle cells, with a proliferation of spindle cells, with no atypia, absence of necrosis and mitoses. Positive immunohistochemical staining for desmin and smooth muscle actin positive with negative staining for CD34, S100 protein and DOG 1 (Figure 2).

      Result

      She remains asymptomatic, and the medical oncology team decided to maintain clinical follow-up with a chest CT scan.

      Despite the increase of the lesion, the patient was asymptomatic and maintained a follow-up in our service.

      Conclusion

      Although MLM is a rare condition, it should be considered in the differential diagnosis in women with a past medical history of uterine leiomyoma. Accurate histopathological and immunochemistry analysis are necessary for the final diagnosis. Due to the slow growth of pattern, most of the patients can be followed with no active specific treatment. There are few similar cases described in the literature and the is no standard treatment in this scenario. Further studies are warranted to evaluate the best treatment option for these patients.

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    P1.09 - Pathology (ID 173)

    • Event: WCLC 2019
    • Type: Poster Viewing in the Exhibit Hall
    • Track: Pathology
    • Presentations: 1
    • Now Available
    • Moderators:
    • Coordinates: 9/08/2019, 09:45 - 18:00, Exhibit Hall
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      P1.09-04 - Comprehensive Genomic Profiling in a Brazilian Cohort of Lung Cancer Patients: Real-World Impact (Now Available) (ID 2712)

      09:45 - 18:00  |  Author(s): Mariana Ribeiro Monteiro

      • Abstract
      • Slides

      Background

      The implementation of comprehensive genomic profiling (CGP) for every patient would ideally inform on all types of alterations, both frequent and rare events that might be useful for treatment. However, less than 50% of Brazilian lung cancer patients have access to any molecular testing. Giving the lack of literature data regarding CGP and clinical practice change, we aimed to evaluate how CGP changed patient treatment in a fully-annotated cohort of lung cancer in Brazil.

      Method

      A retrospective study was conducted to review lung cancer patients for whom CGP was performed from October 2017 to February 2019 in a national, private oncology institution. Patients with all histological subtypes tested with Foundation One (F1) were included. Data regarding microsatellite instability (MSI), tumor mutational burden (TMB) and genomic findings were collected, as well as therapies/ clinical trials with possible clinical benefit. Demographic data were collected from chart review.

      Result

      From 25 patients included in this cohort, 56% were male with a median age of 64-year-old. Tissue and blood sample were analyzed in 80% and 20%, respectively. The most common histological subtype was adenocarcinoma (68%) followed by squamous cell carcinoma (12%). CGP was ordered in 16% of treatment-naive patients; 52% in the first-line treatment and 8% and 12% after second and third line, respectively. None of them had MSI and 12% had high TMB. The most frequent genomic alterations were TP53 (64%); KRAS (32%); STK11 and ARID1A (16%); PIK3, CDKN2AB, and RB1 (12%); ATM, CTNNB1, ERBB2, MLL2, MSH2, PTPN11 and BRCA (8%). One patient was negative for EGFR mutation, tested by COBAS, but was found to have EGFR mutation by CGP. Although CGP showed up to 15 therapies and 37 clinical trials available for this cohort, none of the physicians have changed treatment after testing results due to limited access to clinical trials or one death before the beginning of anti-EGFR therapy.

      Conclusion

      In our cohort, 25 patients with lung cancer had CGP tested during 16 months of follow-up, highlighting the limited access to the test. For most cases, CGP was ordered later during the treatment which could negatively impact on patient outcome. Furthermore, due to a paucity of available clinical trials and lack of access to new drugs in the country, the use of CGP had a limited impact in clinical decision making.

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