Recurrent Mucinous Lung Cancer With Dose-Dependent Afatinib Responses

Patient Info: Anonymized, Female, Under 40 | Stage Metastatic/Advanced

Biomarkers: SDC4-NRG1 fusion; PD-L1 not expressed; low tumor mutation burden

Metastatic Site: bilateral lungs

She had progressive lung disease after several targeted-treatment attempts and was receiving paclitaxel with bevacizumab as of February 2020.

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Aggressive Presumed Ovarian Solid Pseudopapillary Tumor With Widespread Metastases

Patient Info: Anonymized, Female | Stage Metastatic/Advanced

Metastatic Site: peritoneum|pelvic soft tissue|inguinal lymph…

The disease progressed rapidly across multiple abdominal and nodal sites. She died from disease-related complications 2 months after the oncology consultation while receiving induction chemotherapy.

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Breast Adenoid Cystic Carcinoma That Later Spread to Bone and Lung

Patient Info: Anonymized, Female | Stage Metastatic/Advanced

Metastatic Site: bone|lungs

Bone and lung metastases were detected in the fourth year after surgery.

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Right Small Cell Lung Cancer Progressing During Pembrolizumab

Patient Info: Anonymized, Male, 70+ | Stage Metastatic/Advanced

Metastatic Site: pleura|liver

The right small cell lung cancer progressed with malignant pleural effusion and liver metastases. His condition declined rapidly, and he died on March 8, 2018.

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Gastric Cancer Spreading to the Thumb

Patient Info: Anonymized, Female, 70+ | Stage Metastatic/Advanced

Metastatic Site: right thumb distal phalanx

She had advanced gastric cancer with pancreatic involvement and a painful thumb bone metastasis. Her treatment remained palliative because she was too frail for chemotherapy.

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Colon Cancer Metastasis Found Inside a Thyroid Nodule

Patient Info: Anonymized, Male, 50s | Stage Metastatic/Advanced

Biomarkers: KRAS mutated; thyroid metastasis CDX2 positive and CK20 positive; PAX8/TG/TTF-1 negative

Metastatic Site: lungs|thyroid

Follow-up was planned after thyroid surgery, with no adjuvant treatment for the coexisting low-risk thyroid lesion.

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Rectal Cancer Recurrence at a Colostomy Site

Patient Info: Anonymized, Female, 50s | Stage Metastatic/Advanced

Metastatic Site: abdominal wall|peritoneum

She was alive 6 months after palliative radiotherapy for recurrent disease at the colostomy and abdominal wall.

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Small Cell Lung Cancer With Unusual Colon Metastases After Afatinib

Patient Info: Anonymized, Female, 60s | Stage Metastatic/Advanced

Biomarkers: EGFR exon 19 deletion

Metastatic Site: liver|adrenal glands|bone|brain|ascending…

The cancer progressed after an initial response to afatinib, with new brain and colon metastases. She died from respiratory failure on August 1, 2016.

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ROS1-positive lung adenocarcinoma presenting with cancer spread across the abdomen

Patient Info: Anonymized, Male, 50s | Stage Metastatic/Advanced

Biomarkers: ROS1 rearrangement-positive; high PD-L1 expression.

Metastatic Site: peritoneum and omentum; pleura

Crizotinib relieved his respiratory and abdominal symptoms, and six-month imaging showed no residual disease or progression while treatment continued.

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Pemphigus Vulgaris After Rectal Cancer Surgery and Ileostomy

Patient Info: Anonymized, Female, 50s | Stage Metastatic/Advanced

Clinicians found no evidence of residual internal malignancy during evaluation of her skin disease, and the pemphigus lesions healed after rituximab with remission maintained for 14 months.

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Stable Brain Metastases During Niraparib Maintenance for Ovarian Cancer

Patient Info: Anonymized, Female, 60s | Stage Metastatic/Advanced

Biomarkers: CA-125 4019 kU/L; pathogenic germline BRCA1 mutation

Metastatic Site: brain

After 17 months of niraparib, her brain metastases remained stable. She had a performance status of 0 and reported a full, normal quality of life.

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Gastric Cancer Metastasis to the Hand Treated With Radiation

Patient Info: Anonymized, Male, 50s | Stage Metastatic/Advanced

Metastatic Site: liver|adrenal glands|left hand bones

Radiation relieved the hand pain and swelling and restored movement. At 6 months, he remained alive and pain-free in the hand, while the underlying metastatic gastric cancer remained present.

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Colon Cancer and a Separate Liposarcoma Recurring at the Same Time

Patient Info: Anonymized, Male, 60s | Stage Metastatic/Advanced

Metastatic Site: liver|pelvic lymph node

Follow-up imaging showed no evidence of colon cancer after FOLFIRI produced a complete response in the liver and pelvic lymph node. He remained without evidence of disease 1.7 years after recurrence.

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Speech and Swallowing Support After Lung Cancer Relapse

Patient Info: Anonymized, 70+ | Stage Metastatic/Advanced

Metastatic Site: both lungs

The lung cancer relapsed with mediastinal and supraclavicular lymph-node involvement and metastases in both lungs. Ongoing speech and swallowing support prevented reported dysphagia complications.

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Gastric Cancer Presenting as a Thickened Neck Skin Plaque

Patient Info: Anonymized, Male, 60s | Stage Metastatic/Advanced

Biomarkers: CK7 positive; ER negative; PR negative; GCDFP negative

Metastatic Site: skin of the neck

He declined further management and died within 3 months of presentation.

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Rectal Signet Ring Cell Cancer With Rapid, Unusual Metastatic Spread

Patient Info: Anonymized, Male, Under 40 | Stage Metastatic/Advanced

Metastatic Site: peritoneum|lumbosacral vertebrae|bone marrow|right…

The cancer recurred 3 months after surgery and spread rapidly to the peritoneum, bones, bone marrow, orbit, and skin. He later entered palliative care.

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Ovarian Cancer Relapse Causing Fluid Around the Heart

Patient Info: Anonymized, Female, 50s | Stage Metastatic/Advanced

Biomarkers: PAX8 positive; CK7 positive; WT1 positive; p53 positive; ER positive; PR negative; isolated PMS2 loss; MSH2 retained; MSH6 retained; MLH1 retained; two BRCA1 variants of uncertain significance

Metastatic Site: omentum|pericardium

She was alive after completing chemotherapy for the pericardial relapse and was receiving olaparib maintenance. The fluid around the heart did not recur immediately after the surgical window.

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Rectal Cancer Spread to the Optic Nerve and Caused Vision Loss

Patient Info: Anonymized, Male, 40s | Stage Metastatic/Advanced

Biomarkers: BRAF mutant; KRAS wild type

Metastatic Site: lungs|liver|left optic nerve

He had a high burden of metastatic rectal cancer involving the lungs, liver, and left optic nerve. He died about 4 months after presenting with vision loss.

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Rectal Cancer With a Solitary Metastasis in the Thigh

Patient Info: Anonymized, Male, 40s | Stage Metastatic/Advanced

Metastatic Site: right proximal thigh skeletal muscle

A biopsy-confirmed right proximal thigh metastasis remained after chemotherapy. PET/CT found no other active metastatic site, and further surgery plus chemotherapy was planned.

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Splenectomy Reduced Transfusion Needs in Metastatic Lobular Breast Cancer

Patient Info: Anonymized, Female, 40s | Stage Metastatic/Advanced

Biomarkers: ER positive; PR positive; HER2 negative

Metastatic Site: skin|bone|bone marrow|spleen

She remained independent through her last oncology visit 18 months after splenectomy and died 1 month later.

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Metastatic Lung Adenocarcinoma Presenting After Kidney Transplant

Patient Info: Anonymized, Male, 50s | Stage Metastatic/Advanced

Biomarkers: TTF-1 positive

Metastatic Site: bone marrow|spine|bony pelvis

His condition deteriorated rapidly, and he died 1 week after the lung-cancer diagnosis.

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Metastatic Breast Cancer Causing Severe Shoulder and Arm Pain

Patient Info: Anonymized, Female, 50s | Stage Metastatic/Advanced

Metastatic Site: bone

Progressive nodal disease caused disabling brachial-plexus pain. She died about 3 months after placement of the intrathecal pain catheter.

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Breast Cancer Recurring 18 Years After Mastectomy

Patient Info: Anonymized, Female, 70+ | Stage Metastatic/Advanced

Metastatic Site: sternum|lungs|pleura|chest wall

She died during respiratory decline caused by both metastatic breast cancer in the lungs and a separate primary lung cancer.

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A Second Lung Cancer Case With Renal Metastasis Treated by Cryoablation

Patient Info: Anonymized, Male, 50s | Stage Metastatic/Advanced

Metastatic Site: left kidney

The renal lesion was treated with CT-guided cryoablation.

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