Cadenas, Miguel

ABSTRACT A previously healthy 29-year-old man presented with abdominal pain and was found to have a liver mass with periductal infiltration and a stricture of the common bile duct, concerning for cholangiocarcinoma. Hepatic function panel disclosed alanine transaminase 293 U/L, aspartate aminotransferase 122 U/L, γ-glutamyl transferase 2019 U/L, normal total bilirubin, carcinoembryonic antigen, and carbohydrate antigen 19-9. Biopsy established the diagnosis of diffuse large B-cell lymphoma, with no underlying hepatic disease. He was started on polatuzumab-rituximab-cyclophosphamide-doxorubicin-prednisone chemotherapy and achieved complete tumor response. This case highlights the importance of a thorough evaluation of liver tumors and the critical role of tissue diagnosis.

PIK3CA-related overgrowth spectrum (PROS) encompasses rare disorders characterized by vascular malformations and predisposition to thrombotic complications. COVID-19 has been associated with diverse cutaneous manifestations through endothelial dysfunction and microvascular thrombosis. We present a 33-year-old female with PROS and extensive capillary malformations who developed multiple cutaneous ulcerations on her affected right leg exclusively during COVID-19 infection in 2020, with complete resolution following recovery. Preexisting endothelial abnormalities and thrombotic predisposition in PROS may create heightened vulnerability to COVID-19-induced vascular injury, explaining why cutaneous manifestations occurred exclusively in zones of capillary malformation. This susceptibility may be mediated by the Phosphoinositide 3-kinase/ Protein kinase B/ mechanistic target of Rapamycin (PI3K/AKT/mTOR) pathway, which regulates cell growth and vascular homeostasis, is constitutively activated in PROS, and is exploited by SARS-CoV-2 during infection. Clinicians managing patients with vascular malformations should be aware of this potential interaction.

Abstract Liver metastases from well-differentiated thyroid carcinomas are rare. We report 3 patients, 1 with follicular and 2 with oncocytic thyroid cancers, treated for liver metastases with yttrium-90 radioembolization. The 2 patients with oligometastatic disease received ablative radiation doses, while 1 patient with diffuse metastatic liver disease was treated palliatively with 2 sessions of reduced nonablative radiation dose due to a large hepatopulmonary shunt fraction diagnosed at work-up. The 2 cases of oligometastatic disease had a complete local response by imaging criteria, while the third case had a pronounced local partial response, without adverse events. Future guidelines should include radioembolization as a viable option for locoregional therapy of liver metastases of differentiated thyroid cancer not responsive to radioiodine in patients that do not qualify for or refuse hepatic surgery.