Yi Bao, Lei Zhang, Fenfen Jiang, Juanfen Mo
This case suggests that sequential HER2-targeted ADC therapy utilizing different cytotoxic payloads may offer a clinically viable strategy to manage acquired resistance in mUC. Furthermore, it indicates a potentially manageable safety profile regarding renal allograft function. Further longitudinal follow-up and mature survival data are required to establish whether ADCs can serve as a novel standard of care for this specific patient cohort. Additional research is warranted to formulate optimal treatment strategies and safety guidelines for cancer therapy in transplant recipients.
Scrotal Extramammary Paget's disease (EMPD) is a rare cutaneous adenocarcinoma commonly confined to the intraepidermal region, with potential for dermal invasion and metastasis. This report describes a rare case of metastatic scrotal EMPD with bone-marrow involvement. The patient presented with localized pruritic scrotal lesions accompanied by systemic symptoms resulting from distant metastases to the lymph nodes and multiple bones, as well as compromised hematopoiesis caused by tumor cell infiltration of bone marrow. The diagnosis was confirmed by histopathological examination of biopsy specimens from the scrotal lesion, local lymph nodes, and bone marrow. Immunohistochemistry (IHC) revealed HER2 status as 2+ with a negative fluorescence in situ hybridization result. Although the patient presented with a heavy tumor burden involving the bone marrow, he appeared to derive benefit from trastuzumab deruxtecan (T-DXd), a HER2-directed antibody-drug conjugate, and observed disease stability during the treatment period. This case suggests the potentially aggressive biological behavior of EMPD and demonstrates that targeted therapeutics, such as T-DXd, may achieve disease control in cases with low HER2 expression. These findings emphasize the need for further research to establish optimal treatment strategies for metastatic EMPD.