FCCT Blog Post #20
KCMC-FCCT Tumor Board
Radiation-related questions were the focus of two of the three cases discussed at this month’s Tanzania-Minnesota tumor board. This coincides with the opening of the Radiation Treatment Center at KCMC last month. Currently, a number of patients are receiving palliative radiation therapy, and several are undergoing curative treatment for prostate cancer, breast cancer, cervical cancer, rectal cancer and lymphoma
A 54 yr old woman presented with abdominal distension and a large palpable abdominal mass. A CT disclosed a > 20cm intra-abdominal mass that appeared to be arising from the uterus. There was mass effect on the bowel and severe right hydronephrosis. Calcified uterine myomas were identified as well as a small non-calcified lung nodule in the lung bases on the abdominal CT scan. A lytic lesion was seen in the T8 vertebral body. An exploratory laparotomy revealed an unresectable, greater than 40cm abdominal mass infiltrating the retroperitoneum and involving small bowel. A biopsy showed a spindle cell tumor morphologically consistent with a gastrointestinal stromal tumor (GIST). The tumor was CD117 negative suggesting a rare, CD117-negative GIST. Other considerations included a leiomyosarcoma or liposarcoma however additional molecular and immunohistochemical stains could not be performed to provide a definitive diagnosis. It was unclear whether this tumor was originating from the uterus, the small bowel or retroperitoneum. The discussion revolved around the palliative goal of treatment and whether palliative chemotherapy (such as a doxorubicin-ifosfamide-mesna regimen) would provide benefit. CD117-negative GISTs are rare tumors often related to mutations in PDGFR and typically do not respond as well as CD117-positive GISTs to imatinib. Other tyrosine kinase inhibitors, such as sunitinib and regorafenib are not readily available in Tanzania.
A 42 yr old HIV positive woman with a preserved CD4 count of 460 on antiretrovirals developed rapid progression of metastatic squamous cell cancer of the cervix 2 months following total abdominal hysterectomy and bilateral salpingo-oophorectomy (TAH and BSO) for stage 3 cervical cancer. In January, 2026, she had undergone a TAH and BSO at an outside hospital and had biopsy-confirmed para-aortic lymph node involvement. She presented with back and abdominal pain from a rapidly enlarging para-aortic mass infiltrating the psoas muscle. This mass had grown substantially in the past 2 months since surgery and was causing significant pain and disability. The discussion revolved around whether palliative radiation (3000cGy in 10 fractions) or palliative chemotherapy (with a regimen such as carboplatin and paclitaxel) would be the best option. Cervical cancer, historically has been an “AIDS-defining cancer” with the immunosuppressive effects of HIV contributing to a more aggressive course.
A 61 yr old man developed progressive nausea, vomiting, headache and left hemiplegia 19 days after undergoing a subtotal resection of a right temporal grade 3 astrocytoma. Repeat brain imaging identified rapid recurrence of his right sided brain tumor with mass effect and midline shift. Despite mannitol and dexamethasone, he remained severely debilitated. A discussion revolved around goals of care given the severely debilitated status. Treatment options considered included repeat craniotomy vs definitive chemoradiotherapy with temozolomide vs short course palliative radiation in 15 fractions. Gliomas are the most common primary brain tumors in adults in Tanzania. Patients often present late and have poor outcomes. (https://www.ajol.info/index.php/eajns/article/view/276288) Molecular characterization of gliomas in Tanzania with IDH mutation status and MGMT promoter methylation status is virtually unknown.
Randy Hurley MD, cTropMed
Global Health Faculty, University of Minnesota
