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  • Development of pyogenic granuloma with strong vascular endothelial growth factor receptor-2 expression during ramucirumab treatment

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Findings that shed new light on the possible pathogenesis of a disease or an adverse effect
Case report
Development of pyogenic granuloma with strong vascular endothelial growth factor receptor-2 expression during ramucirumab treatment
  1. Tatsuya Ibe1,
  2. Yoichiro Hamamoto1,
  3. Mikage Takabatake2 and
  4. Shingo Kamoshida2
  1. 1 Department of Pulmonary Medicine, National Hospital Organization Nishisaitama-Chuo National Hospital, Tokorozawa, Japan
  2. 2 Laboratory of Pathology, Department of Medical Biophysics, Kobe University Faculty of Health Sciences and Graduate School of Medicine Faculty of Health Sciences, Kobe, Hyogo, Japan
  1. Correspondence to Dr Yoichiro Hamamoto; hamamoto32{at}gmail.com

Abstract

The angiogenesis inhibitor ramucirumab (IMC-1121B) is a fully humanised IgG1 monoclonal antibody targeting the extracellular domain of vascular endothelial growth factor receptor 2. Ramucirumab has been approved as a second-line treatment for lung cancer. Pyogenic granuloma is an acquired, benign vascular tumour of the skin or mucous membrane. We encountered a patient with pyogenic granuloma who was treated with ramucirumab. The patient was a 48-year-old Japanese woman with advanced lung cancer who had been heavily pretreated using several lines of chemotherapy. Ramucirumab was administered as the fifth-line treatment with docetaxel. After 10 days, a painless rice-coloured or pink papule appeared on her finger. One month later, it increased in size to 20 mm. We examined the pathological condition by immunostaining using the resected specimen diagnosed as pyogenic granuloma. Paradoxically, this vascular tumour arose during the administration of an angiogenesis inhibitor.

  • dermatology
  • skin
  • chemotherapy
  • lung cancer (oncology)

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bcr-2019-231464

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    Footnotes

    • Contributors YH designed the study and TI wrote the initial draft of the manuscript. MT and SK contributed to pathological analysis and interpretation of data and assisted in the preparation of the manuscript. All authors approved the final version of the manuscript and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

    • Funding This study was funded by Grant-in-Aid for Scientific Research Program from the Japan Society for the Promotion of Science (JSPS KAKENHI; Grant Number 16K08690).

    • Competing interests None declared.

    • Patient consent for publication Obtained.

    • Provenance and peer review Not commissioned; externally peer reviewed.