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• W4387249772 abstract "SESSION TITLE: Lung Pathology Case Report Posters 8 SESSION TYPE: Case Report Posters PRESENTED ON: 10/09/2023 02:10 pm - 02:55 pm INTRODUCTION: The abscopal effect is described as unintentional tumor reduction in response to a treatment of a tumor in a remote region. Abscopal is a Latin word that means away from target. This case report highlights the abscopal effect seen in a woman with metastatic papillary thyroid cancer in the lungs. Significant widespread tumor regression was seen shortly after treatment with localized embolization to intercostal arteries and bronchial arteries of the right upper lobe. CASE PRESENTATION: A 75-year-old female born in Okinawa, Japan who immigrated to the United States in 1968 with a past medical history of tobacco use, and papillary thyroid cancer presented to the pulmonary clinic with dyspnea on exertion and hemoptysis. Her papillary thyroid cancer was diagnosed in 1995 with local spread to the neck and biopsy-proven spread to the right lung. The pathology report confirmed papillary thyroid carcinoma after which she underwent a complete thyroidectomy. Radioactive iodine treatment was done, and she went into 9 years of remission. In 2004, MRI and a 1.5 cm x 2.0 cm mass showed return of her cancer for which she received radioactive iodine again. A thyrogen-stimulated I-131 scan in February 2016 showed subtle iodine uptake within the anterior/superior mediastinal area. A CT of the chest and abdomen in March 2016 revealed an enhancement in the right upper lobe of the lung compared to a CT from December 2014, along with sub-centimeter nodules scattered throughout the upper and lower lobes bilaterally that remained stable. She was seen in the pulmonary clinic initially in 2019 for dyspnea with exertion, and a cough with transient, pink-tinged mucus, however, in 2021 her hemoptysis worsened. Bronchoscopy revealed blood emanating from the posterior segment of the right upper lobe. Interventional radiology performed an embolization of her superior and inferior bronchial artery in July 2022 with significant improvement in her symptoms. A repeat PET scan after the localized embolization showed marked improvement to a comparison scan in June 2022. There was a reduction in size, number, and metabolic activity of numerous pulmonary nodules, and lymphadenopathy. Unfortunately, a repeat scan done 4 months later showed interval worsening. The patient again underwent embolization and continues to follow her specialists. DISCUSSION: The mechanism of action described by the abscopal effect remains unclear. Another case report highlights a patient receiving radiation therapy for hepatocellular carcinoma with metastases to the lungs. There was a regression of lung nodules after receiving embolization and localized radiation therapy to the liver lesion (2). The abscopal effect is thought to evoke a response by cytokine and immune cascade, which has a response to tumors in a remote region. However, unlike the case described above, almost all abscopal responses have been seen with radiation therapy (3). CONCLUSIONS: A patient with metastatic thyroid cancer received treatment with embolization to a metastatic right intercostal artery and bronchial artery with hyperenhancement for persistent hemoptysis. This led to a widespread tumor burden reduction on a follow-up PET scan. This case demonstrates an abscopal effect with embolization, which is usually seen with radiation therapy. REFERENCE #1: February 23, 2023, January 20, 2023, & March 9, 2023. (n.d.). Investigating the abscopal effect as a treatment for cancer. National Cancer Institute. Retrieved March 30, 2023, from https://www.cancer.gov/news-events/cancer-currents-blog/2020/cancer-abscopal-effect-radiation-immunotherapy REFERENCE #2: Nakanishi, Mitsuru M.D.; Chuma, Makoto M.D.; Hige, Shuhei M.D.. Abscopal Effect on Hepatocellular Carcinoma. American Journal of Gastroenterology 103(5):p 1320-1321, May 2008. REFERENCE #3: Hatten, S. J., Lehrer, E. J., Liao, J., Sha, C. M., Trifiletti, D. M., Siva, S., McBride, S. M., Palma, D., Holder, S. L., & Zaorsky, N. G. (2022). A patient-level data meta-analysis of the abscopal effect. Advances in Radiation Oncology, 7(3), 100909. https://doi.org/10.1016/j.adro.2022.100909 DISCLOSURES: No disclosure on file for Brian Cuneo No relevant relationships by Imran Khan" @default.
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• W4387249772 title "THE ABSCOPAL EFFECT: A CASE OF WIDESPREAD PULMONARY TUMOR BURDEN REDUCTION AFTER LOCALIZED EMBOLIZATION" @default.
• W4387249772 doi "https://doi.org/10.1016/j.chest.2023.07.3056" @default.
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