Gallbladder cancer with tumor thrombus in the superior vena cava

BACKGROUND:Gastrointestinal cancers,especially pancreatobiliary cancers,are frequently associated with or are complicated by thromboembolic phenomena due to hypercoagulability and/or altered venous drainage,especially of the abdomen and lower limbs.This report describes an unusual and interesting case of gallbladder carcinoma developing a viable tumor thrombus in the superior vena cava(SVC)with resultant SVC obstruction,while on gefitinibbased anti-epidermal growth factor receptor(EGFR)therapy.METHODS:A 60-year-old woman was incidentally diagnosed to have gallbladder cancer on cholecystectomy.She had disease recurrence and received systemic chemotherapy followed by gefitinib-based anti-EGFR therapy.Subsequently,while on gefitinib-based therapy,she presented with clinical signs and symptoms suggestive of SVC thrombosis.RESULTS:A whole body PET scan revealed a metabolically active tumor thrombus in the SVC,besides other sites of metabolically active disease inclusive of the lung parenchyma, lymph nodes and abdomen.She was treated with antithrombotics and external beam radiotherapy directed to the SVC thrombus leading to symptomatic relief.She continues to survive on the day of writing this report.CONCLUSIONS:This rare complication,though theoretically possible,is unreported because of the short overall survival of advanced gallbladder cancer patients.This highlights that with the availability of better chemotherapeutic/biotherapeutic agents for increasing in the lifespan of cancer patients,we may come across such cases more frequently in the future.

EGFR mutation--a commonly neglected mutation in squamous cell lung carcinoma

Lung cancer is the leading cause of cancer-related death worldwide.Advances in molecular biology have unveiled various targetable mutations with epidermal growth factor receptor(EGFR)being most common.EGFR testing is recommended for all locally advanced or metastatic adenocarcinoma lungs but recommendation in squamous histology is uncertain.However,just on the basis of histology,EGFR testing should not be withheld in patients diagnosed as squamous cell cancer on small biopsy,in females,never smokers and Asians.We report two cases with squamous cell lung cancer diagnosed on small biopsy,in non smoker females with EGFR mutations emphasizing the importance of testing in such population.