Individualized vaginal applicator for stage IIb primary vaginal adenocarcinoma:A case report

BACKGROUND Primary vaginal cancer is rare and most vaginal tumors are metastatic,often arising from adjacent gynecologic structures.Primary vaginal cancers are also more common among postmenopausal women and most of these are squamous cell carcinomas,with adenocarcinomas being relatively rare.Vaginal bleeding is the most common clinical manifestation of vaginal adenocarcinoma.About 70%of vaginal adenocarcinomas are stage I lesions at the time of diagnosis,for which radical surgery is recommended.However,more advanced vaginal cancers are not amenable to radical surgical treatment and have poor clinical outcomes.Optimal treatments modes are still being explored.Here,we report a rare case of stage IIb primary vaginal adenocarcinoma for which an individually designed vaginal applicator for after-loading radiotherapy was used to achieve good tumor control.CASE SUMMARY A 62-year-old woman presented to our clinic after 3 months of abnormal postmenopausal vaginal bleeding.Gynecological examination,computed tomography(CT),and positron emission tomography-CT showed a large mass(about 5 cm)on the anterior vaginal wall.Colposcopy biopsy confirmed adenocarcinoma of vaginal origin.After three cycles of carboplatin plus paclitaxel chemotherapy,the lesion partially shrunk.The patient then received external irradiation of 45 gray(gy)in 25 fractions,which further reduced the vaginal lesion,followed by after-loading radiotherapy of 30 gy in 5 fractions with an individually designed vaginal applicator.Three months later,magnetic resonance imaging showed a slight thickening CONCLUSION Primary vaginal adenocarcinoma is rare,and prognosis is poor in most vaginal cancers of locally advanced stages,which cannot be treated with radical surgery.Better tumor control can be achieved with an individualized vaginal applicator that allows administration of a higher radical dose to the tumor area while protecting normal tissues.

Primary Mucinous Adenocarcinoma of the Thymus: A Case Report and Literature Review

THYMIC carcinoma is a rare malignant tumor, but the most common malignant tumor of the ante-rior mediastinum. According to the latest World Health Organization （WHO） classification, primary thymic carcinoma has a variety of histological types, mainly including squamous cell, basaloid, mucoepidermoid,lymphoepithelioma-like, sarcomatoid, clear cell and neuro-endocrine carcinomas, and papillary adenocarcinoma.1-4 Thymic mucinous adenocarcinoma was discovered in re-cent years, and only 10 cases were reported. In this paper, we described a case of thymic mucinous adenocarcinoma, the histopathological findings and immunohistochemical results.

One-stage resection of four genotypes of bilateral multiple primary lung adenocarcinoma:A case report

BACKGROUND The incidence of multiple primary lung cancer(MPLC)in China is 0.52%-2.45%.Most primary lung cancer cases have reported two lesions or three in rare cases.We report a rare case of bilateral simultaneous multiple primary lung adenocarcinoma of four different genotypes.CASE SUMMARY A 58-year-old woman was admitted to our hospital on June 29,2021,and upon physical examination,four multiple pulmonary nodules were identified in both lungs.Further computed tomography(CT)images revealed the presence of ground glass nodules,predicted to be high-risk cancer lesions by artificial intelligence.With the guidance of three-dimensional reconstruction of preo-perative CT images,the nodules were resected under thoracoscopy.Postoperative pathological investigation revealed that the nodule types were adenocarcinoma in situ,invasive alveolar adenocarcinoma,and microinvasive adenocarcinoma.The excised nodules were further sequenced using high-throughput sequencing(semiconductor sequencing method)of 26 lung cancer genes to confirm that the four lesions were not homologous.The patient was discharged on postoperative day 8,that is,on July 15,2021.One month later,she returned to the hospital for followup and reexamination.Chest CT examination showed that she had re-covered well,and no obvious exudation and effusion were found in both pleural cavities.Evaluation of postoperative pulmonary function showed that her forced vital capacity was 1.40 L(preoperative value,2.27 L)and forced expiratory volume was 1.24 L(preoperative value,2.23 L).CONCLUSION The surgical plan for multiple pulmonary nodules should be carefully considered.For carefully selected patients with concurrently occurring multiple lung nodules in both lungs,sublobectomy is a safe and feasible plan for concurrent bilateral resection of the lesions.Genetic sequencing is necessary for MPLC diagnosis and treatment.