ABSTRACT We report the case of a 54‐year‐old woman with asthma, eosinophilic chronic rhinosinusitis, eosinophilic gastroenteritis and allergic bronchopulmonary aspergillosis (ABPA). She had long‐term cat exposure and received low‐dose prednisolone. Chest computed tomography showed mucus plugging in the right middle and left upper lobes, and laboratory findings showed eosinophilia, elevated serum immunoglobulin E (IgE), and positive Aspergillus ‐specific IgE and IgG. Following initiation of dupilumab to minimize systemic corticosteroid exposure, ABPA, sinonasal disease and lung function improved. Fourteen months later, a new opacity appeared in a bronchiectatic lesion of the right middle lobe, raising concern for ABPA relapse. Bronchoscopy revealed purulent secretions, and Pasteurella multocida ( P. multocida ) was isolated from bronchoscopic specimens, supporting secondary bacterial infection. The infection improved with antimicrobial therapy. Dupilumab was continued, and oral corticosteroids were eventually discontinued without recurrence of infection. This case highlights the importance of distinguishing secondary infection from ABPA relapse when new opacities develop during biologic therapy.
ABSTRACT Epithelial ovarian cancer typically spreads via transcoelomic dissemination and lymphatic pathways. Extra‐abdominal metastases presenting as solitary anterior mediastinal lesions are rare. Ovarian clear cell carcinoma (CCC) is characterized by aggressive local behaviour but has a lower propensity for distant metastasis than serous carcinoma. Furthermore, it is less sensitive to platinum‐based chemotherapy than other epithelial ovarian cancers. Here, we report a rare case of ovarian CCC with a solitary anterior mediastinal metastasis after primary surgery. A woman in her 50s had a 2.6‐cm anterior mediastinal mass during postoperative surveillance. Considering progressive lesion enlargement and increased 18F‐fluorodeoxyglucose uptake on positron emission tomography‐computed tomography, complete surgical resection via median sternotomy was performed. Histopathological and immunohistochemical findings confirmed the presence of metastatic ovarian CCC. The patient remained disease‐free for 6 months postoperatively. Complete surgical resection may represent an effective treatment option for isolated recurrence of chemoresistant histological subtypes.
ABSTRACT A 51‐year‐old woman presented with a solitary pulmonary nodule, hilar and mediastinal lymphadenopathy and progressive sensory disturbances. FDG‐PET demonstrated intense uptake in the pulmonary and hilar lesions, while spinal MRI showed thoracic cord enhancement. Lung cancer‐associated paraneoplastic neurological syndrome was initially suspected. Biopsies of the endobronchial lesion and a mediastinal lymph node revealed noncaseating granulomas without malignancy. Ocular involvement and neurological findings supported pulmonary sarcoidosis with probable neurosarcoidosis. Corticosteroid therapy improved neurological symptoms. Long‐term follow‐up showed a stable pulmonary nodule and sustained neurological improvement. This case highlights the importance of tissue diagnosis and careful neurological assessment when pulmonary nodules and sensory disturbances suggest malignancy.
ABSTRACT Hepatoid adenocarcinoma of the lung (HAL) is a rare pulmonary malignancy that resembles hepatocellular carcinoma morphologically and poses diagnostic challenges, particularly when alpha‐fetoprotein (AFP) is absent. We report a man in his 50s with chronic obstructive pulmonary disease and a solitary 1.9‐cm right upper lobe nodule. Percutaneous biopsy identified non‐small cell carcinoma without establishing the subtype. Video‐assisted thoracoscopic right upper lobectomy with mediastinal lymphadenectomy revealed a hepatoid tumour expressing HepPar‐1 and CK7 but not AFP, arginase‐1 or glypican‐3. The absence of a hepatic lesion on staging imaging supported a pulmonary primary. The tumour was pT1bN0 with no clinically detected metastases. At 6 months after resection, there was no evidence of recurrence. This case illustrates the limitations of small biopsies and isolated immunohistochemical markers in diagnosing an AFP‐negative pulmonary hepatoid tumour.
ABSTRACT Severe cutaneous adverse reactions to taletrectinib, a next‐generation ROS1 inhibitor for ROS1‐rearranged non‐small cell lung cancer, remain poorly described. A 52‐year‐old woman with ROS1‐rearranged lung adenocarcinoma developed a Grade 3 rash during crizotinib therapy. After improvement, taletrectinib was initiated. On Day 21, conjunctival hyperaemia appeared, followed by high fever, neutropenia, widespread trunk‐dominant erythema, and lower‐lip mucosal involvement. Although epidermal detachment, a positive Nikolsky sign, and characteristic epidermal necrosis were absent, and typical target lesions were not documented during the acute phase, the clinical course was considered consistent with probable Stevens–Johnson syndrome. Fever and ocular symptoms rapidly improved after taletrectinib discontinuation and systemic corticosteroid therapy. Infection and human herpesvirus 6 (HHV‐6) reactivation were not identified, and ALDEN and Naranjo assessments supported a probable association with taletrectinib. During ROS1‐TKI therapy, fever and neutropenia should prompt consideration of severe cutaneous adverse reactions as well as infection.
