Case 9

CASE DESCRIPTION

A 45-year-old lady was diagnosed with carcinoma Endometrium and treated outside 2 years back with surgery followed by 6 cycles of adjuvant chemotherapy. On follow-up, she developed recurrence within one year with liver metastasis. Considering she had metastatic disease, she was declared palliative. So, she was considered for palliative chemotherapy. On restaging, FDG PET CT showed only a single large liver segment VIII lesion. She came to us for a second opinion.

Consultation and diagnosis

Prompt and accurate diagnosis made in-house

Tumour board

A multi-disciplinary team deliberated on action

Individualized care

Patient’s mental makeup taken into consideration

Modular care

A suite of therapies that contribute to holistic healing

WHAT WE DID

The case was discussed in the Tumour board and a decision was made to revisit the histology because such an early recurrence with liver only site of the disease on chemotherapy is a little rare. Outside, the biopsy showed poorly differentiated carcinoma and IHC was not done before declaring her palliative. After revisiting the biopsy, it showed up as neuroendocrine carcinoma which is a different entity in itself. So we started chemotherapy relevant to the histology and she showed an excellent response. After 6 cycles, we planned to observe her for  3 months to check the biology. On restaging, the FDG PET CT scan showed liver-limited disease with excellent response. After the tumour board discussion, we planned for a Right hepatectomy. Her FLR was 40 percent. She underwent Right hepatectomy and did well after surgery. She was discharged on POD4. To our surprise, the liver histology showed up as neuroendocrine but diaphragmatic nodes as adenocarcinoma from ca Endometrium positive for hormone receptors.

So, liver lesions were probably primary neuroendocrine carcinoma, which is very rare. We started her on hormonal therapy based on nodal disease histology.

• Involved Tumour Board
• Chemotherapy administered
• Underwent surgery
• Personalised approach
• Palliative turned curative

FINAL RESULTS

Now, it has been  18 months Post Op. The recent FDGPETCT showed no disease, the patient is extremely fit and working with a good quality of life.

Learning: Best-thinking brains with personalised approaches can change the outcome. A patient who was declared palliative is now curative and disease-free.