We report right here the case of a patient with an agressive cystadenocarcinoma on the par otid which has a BRAF mutation treated by using a BRAF inhibitor. Case report Mr B. is actually a 69 year old guy without any important past med ical historical past. He presented to our Institute that has a left pre tragus mass that appeared a few weeks in the past. His general practitioner ordered a Computed Tomography scan then a Magnetic Resonance Imaging that revealed a bifocal parotid mass. The first nodule extended into the superficial lobe in the parotid along with the second through the angle from the mandible using a marked osteolysis. A nodule was also noticed with the upper front from the maxillary left sinus with no continuity with former 1. Clinically no mu cosal lesion was identified. The fine needle aspiration bi opsy of the parotid lesion exhibited glandular epithelial cells suspicious of malignancy.
The biopsy then demon strated a papillary adenocarcinoma suggesting a cystade nocarcinoma. Immunohistochemical evaluation of HER2 showed grade two overexpression but no HER2 gene ampli fication by FISH. Posi tron Emission Tomography staging showed distant metastases. selleck chemical tsa inhibitor Many bone hyperfixations have been localized in C3 ideal costal arch, C6 with posterior wall destruction, L4 pedunculate, left femur and pelvis. A chemotherapy was initiated on July 2011. 3 cy cles of cisplatin one hundred mg/m2 and five fluorouracil 1000 mg/ m2/d had been delivered with excellent tolerance. The CT scan evaluation uncovered a stabilization with the mass formulated on the expense in the superficial lobe from the parotid but a marked progression of bone localizations of the malar mass and of mandible osteolysis with pathological fracture. Distant bone metas tases progressed as well to the MRI with an epidural exten sion of C6 damage and physical appearance of T8 and L5 lesions.
In October 2011, palliative selleck chemical radiation treatment was admin istered on the main parotid mass, the adjacent mandible lesion and on symptomatic distant bone localizations. The dose delivered was thirty Gy in ten fractions. The April 2012 CT scan evaluation reported a discrete regression on the irradiated parotid mass but a additional professional gression from the malar mass measured at 53 mm. Furthermore, enlarged mediastinal lymph nodes appeared in 2R, 4R and seven too as many osseous internet sites through the entire pelvis and spine. Given the aggressiveness and resistance of this ailment to radio chemotherapy, an extra molecular examination was requested to attempt to identify mutations on EGFR, KRAS and BRAF genes. No mutations had been uncovered except for BRAF. A polymerase chain reaction followed by an allele particular oligonucleotide revealed a V600E mutation of BRAF. A compassionate therapy that has a BRAF inhibitor was begun at a dose of 240 mg bid for 2 months after approval of internal ethic committee.