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Dillip Kumar Parida



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    EP1.09 - Pathology (ID 199)

    • Event: WCLC 2019
    • Type: E-Poster Viewing in the Exhibit Hall
    • Track: Pathology
    • Presentations: 1
    • Now Available
    • Moderators:
    • Coordinates: 9/08/2019, 08:00 - 18:00, Exhibit Hall
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      EP1.09-15 - Unusual Malignancies of Lung-Experience from a Tertiary Care Centre of Eastern India (Now Available) (ID 184)

      08:00 - 18:00  |  Author(s): Dillip Kumar Parida

      • Abstract
      • Slides

      Background

      Carcinoma lung accounts for 12.3% of all malignancies globally and is the leading cause of deaths due to malignancies.Pathologically,among various types of lung carcinomas;adenocarcinoma,squamous cell carcinoma,small cell and large cell carcinoma are the common varieties encountered.However there are certain uncommon variants of malignancies arising in lung which require distinct diagnostic and management approach and hence pose a challenge to the oncologist.Hereby we present our experience with some of these unusual pathologic variants of lung malignancies with relevant literature review.

      Method

      A retrospective analysis was done from the hospital records of patients visiting at a tertiary cancer hospital of eastern India between June 2013 to December 2018.All patients with biopsy or cell block proven diagnosis of lung malignancies were included in the study.Common pathological types of lung carcinoma such as adenocarcinoma,squamous cell carcinoma and small cell carcinoma were excluded from the study.

      Result

      Among a total of 216 lung malignancies presented during this time period, six patients presented with unusual pathological variants such as: synovial sarcoma,lymphoma(diffuse large B cell lymphoma),neuroendocrine carcinoma,mucoepidermoid carcinoma,basaloid squamous cell carcinoma and adenosquamous carcinoma(one case from each pathological type).All six patients in the study were male with age range 31-74 years(median-49 years).Out of these six cases,laterality was evenly distributed i.e three cases had malignancies on left lung whereas in other three cases right lung was involved. Three patients had distant metastasis during presentation(synovial sarcoma, adenosquamous carcinoma and DLBCL) whereas other three patients were nonmetastatic at presentation.The presentation,histopathological diagnosis and immunohistochemistry,treatment received and followup of the patients are briefly summerised in the table.Among these six patients,one has died(adenosquamous carcinoma),one has lost followup and four patients are on followup(range-2-24 months).

      Table showing clinicopathological and treatment details of patients
      sl no sex Age(yrs) laterality histopathology IHC stage at presentation mets treatment f/u
      1 m 37 left

      synovial sarcoma

      Bcl-2,CD99+, CD34-,CK7- III no 3X(adriamycin+ifosfamide)--progressive disease lost to f/u
      2 m 67 left

      adenosquamous carcinoma

      IV Bone(clavicle,rib) 6X(paclitaxel+carboplatin)--zolendronate,tab gefitinib Death after 8 mnth f/u
      3 m 48 right neuroendocrine carcinoma Synaptophysin, Chromogranin A+ve,TTF-1 weakly +ve III no 3XEP--excision of mediastinal mass with rt upper lobectomy 24 mnth
      4 m 50 right DLBCL CD45,CD20,BCl2+ IV adrenal gland 6XRCHOP--2XRituximab+prednisolone 2 mnth
      5 m 74 right basaloid squamous cell carcinoma panCK,p40,p63+,Mib-1>70% IIIA no 3X(gemcit+carbo)--partial response--CCRT 15 mnth
      6 m 31 left mucoepidermoid carcinoma p63,CK5/6/7+, Her2neu+ IIIA no thoracotomy & resection--4XTCH--maintenance TrastuzumabX14 2 mnth

      Conclusion

      Unusual malignancies of lung pose a diagnostic and therapeutic challenge to the oncologist in clinical practise owing to paucity of relevant data and insufficient studies.However they are treated according to the specific histopathologic subtype and stage of presentation.More studies are needed to be conducted regarding this subgroup of malignancies and their management

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    EP1.14 - Targeted Therapy (ID 204)

    • Event: WCLC 2019
    • Type: E-Poster Viewing in the Exhibit Hall
    • Track: Targeted Therapy
    • Presentations: 1
    • Now Available
    • Moderators:
    • Coordinates: 9/08/2019, 08:00 - 18:00, Exhibit Hall
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      EP1.14-38 - Prolonged Survival in a Case of NSCLC with Recurrent Brain Metastasis - A Case Report (Now Available) (ID 375)

      08:00 - 18:00  |  Author(s): Dillip Kumar Parida

      • Abstract
      • Slides

      Background

      Carcinoma lung remains the most common cause of cancer related deaths in men globally.Approximately 10 percent of newly diagnosed patients with advanced non-small cell lung cancer (NSCLC) have brain metastases. Presence of brain metastases is associated with very poor prognosis with decreased survival and compromised quality of life in patients even after intensive treatment with multimodal approach.Though the survival varies according to performance status and presence of other prognostic factors, the survival in non small cell lung cancer with brain metastasis has increased to some extent in last two decades(median survival ranges between 7 -12 months in various studies).Hereby we present our experience with a case of adenocarcinoma lung with brain metastasis on presentation who has received multiple lines of treatment approach and leading a happy and hearty life after 8 years(96 months) of diagnosis.

      Method

      Section not applicable

      Result

      CASE REPORT

      A 45 year old nonsmoker male presented with constant headache with memory loss and on evaluation was found to have a SOL in the left temporal region with few other small lesions at other sites in brain along with right lung mass and was diagnosed as primary lung cancer with brain metastasis.CT guided biopsy of the lung mass showed adenocarcinoma lung.EGFR and ALK were non mutated.He received palliative whole brain radiotherapy followed by four cycles of chemotherapy with pemetrexed and carboplatin regimen.Received EBRT to right lung mass. Developed relapse after one year and underwent surgery.After six months,he developed recurrence at brain,for which surgical excision of the brain lesion(metastatectomy) was done followed by reirradiation to brain.Again he developed brain recurrence following which he received six cycles of Pemetrexed and Carboplatin followed by six cycles of maintenance Inj Pemetrexed.Again developed brain recurrence after one year which was surgically resected out following which he received Tab Erlotinib+ Tab Temezolamide . Recurrence of brain lesion was again encountered after four months for which he received six cycles of Inj Bevacizumab+ Nab-Paclitaxel + Carboplatin. Evaluation with whole body PET-CT scan and MRI brain showed complete metabolic response at primary site(lung) and partial response at brain. Then he received maintenance Inj Bevacizumab for six cycles. Then after one year,on recurrence in brain with surgical excision of the tumor and subsequent evaluation it was found that he had T790M mutation and hence was planned for Tab Osimertinib. He is on Tab Osimertinib since last 26 months. Recent evaluation was done two months back in form of whole body PET-CT scan and MRI brain which showed complete response at both primary(lung) site and brain.Patient is doing fine till date with a followup period of 96 months since upfront presentation with brain metastasis.

      Conclusion

      Treatment approach for NSCLC has seen a paradigm shift in last few years with the increased role of targeted therapies which has improved the survival.Hence biopsy and identifying the druggable targets have become of prime importance in managing lung malignancies.Metastatectomy and target oriented approach has always proven to be beneficial in oligometastatic settings.

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