A clinical, as well as a diagnostic challenge, is posed by both synchronous and metachronous tumors which are amplified when the uncommon neuroendocrine histology is shown by one of the samples. The researchers give an account of a patient who was diagnosed with sarcoidosis and was treated for an ovarian and endometrial neoplasm that recurred with two different histologies (high grade neuroendocrine and adenocarcinoma). Both of these were related to microsatellite instability (MSI) high status. A mutual ancestry of the three tumors was found through the utilization of targeted next-generation sequencing along with synonymous somatic changes. This helped in treating the patient effectively with a customized immunotherapy routine. There was only a marginal deterioration in her sarcoidosis so there was no need for stopping the immunotherapy. The significance of molecular testing for the ideal treatment of synchronous tumors is brought to attention by this case while also bringing focus on the requirement of communication between both medical and surgical oncologists in patients with MSI-high cancer.

As such, the study highlights three important points. Firstly, the case of a patient with a repetitive gynecological cancer diagnosed as MSI-high endometrial adenocarcinoma and MSI-high neuroendocrine tumor is described. Secondly, a mutual hereditary lineage was shown between the tumors in this case with great response to checkpoint inhibition without the autoimmune disease getting clinically worse. Thirdly, adding to the literature, this research indicates that there is an evolution in tumors with neuroendocrine differentiation in some cancers. It also contends a better comprehension and perhaps improved treatment results might be achieved through molecular-based tactics.

Link:theoncologist.onlinelibrary.wiley.com/doi/10.1002/onco.13525