Current problems in cancer. Case reports最新文献

We report a case of human epidermal growth factor receptor 2 (HER2)-positive Stage IV breast cancer with metastatic lung cancer treated with cryoablation as a first-line treatment. The patient, a 34-year-old woman who voluntarily screened for breast cancer, was referred to our clinic after a mammogram revealed calcification findings. The patient had a tumor in the right breast and lung metastasis. The tumor was 34×31×23 mm with internal heterogeneity in the right mammary gland. Imaging and vacuum-assisted breast tumor biopsy led to a diagnosis of invasive ductal carcinoma (estrogen receptor-positive, progesterone receptor-negative, and human epidermal growth factor receptor 2 positive). The patient received 6 cycles of trastuzumab, and paclitaxel, followed by 11 cycles of trastuzumab, pertuzumab and tamoxifen as pre-cryoablation adjuvant therapy. After chemotherapy, the patient underwent minimally invasive cryoablation treatment followed by fractionated radiation therapy to the entire right breast.

In the last follow-up, 5 years following cryoablation as a first-line treatment after anti-HER2 therapy, a complete local response was recognized, with no evidence of disease progression in the lung metastasis or recurrence of the primary breast tumor. This case report demonstrates that cryoablation is safe and effective, with favorable cosmetic results also for late-stage breast cancer.

Cryoablation, as a minimally invasive treatment for primary site control of Stage IV breast cancer, can provide a good alternative that preserves the quality of life. It can be performed under local anesthesia and be conducted jointly with chemotherapy, radiation therapy, surgery, and immunotherapy.

While pleural schwannomas typically exhibit a male predilection, our case enunciates a distinctive scenario wherein a pleural schwannoma manifested as persistent, uncontrollable coughing in an adult female. The confirmation of diagnosis was achieved through a comprehensive diagnostic approach encompassing X-ray, Computed Tomography (CT) scan, and immunohistochemical analysis. This novel case emphasizes the importance of meticulous diagnostic imaging and histopathological scrutiny in uncommon presentations of pleural schwannoma. Moreover, our findings underscore the significance of considering benign nerve tumors as a plausible differential diagnosis for patients enduring prolonged, unyielding coughing episodes. Ultimately, we believe that early recognition of such infrequent manifestations may facilitate more informed preoperative evaluation and surgical intervention, eventually contributing to improved patient prognoses.

Mammary myofibroblastoma (MFB) is a rare benign spindle cell neoplasm of the breast that can exhibit both epithelial and mesenchymal elements. The histomorphologic features of MFB mimic other potentially more aggressive neoplasms of the breast that may require more involved clinical management beyond a conservative local excision. We present the case of a 71-year-old male with a mammary MFB who underwent core needle biopsy (CNB) of a well-defined, bland spindle cell neoplasm with a subsequent local excision. The case highlights triage of MFB among a broad diagnostic differential at biopsy, particularly given its multipotent differentiation potential and highly variable presentation from the standpoint of both radiology and histopathology. We also discuss the role of RB1 deficiency in distinguishing MFB from other tumor types and non-neoplastic/reactive proliferations.

Purpose

Pure mucinous breast carcinomas (PMBC) are rare cancers that are managed per standard breast cancer treatment protocols. In this study, we review the clinicopathologic features, treatment, and outcomes of patients with PMBC treated at our academic cancer center.

Methods

We searched institutional pathology databases for patients with histologically confirmed PMBC over a 20-year period (January 1998 - October 2018) who received any portion of clinical care at our institution. Archival pathology slides were re-reviewed to confirm the diagnosis and record pathologic features, including the presence or absence of a micropapillary component. We estimated recurrence free survival (RFS) probabilities using the Kaplan-Meier method and evaluated prognostic factors using Cox regression.

Results

A total of 70 cases of PMBC were identified, including 13 with micropapillary features. Median patient age was 65 years (range, 39–94) and approximately 40 % were African American or Asian. The majority of patients had negative lymph nodes (84 %), tumors < 2 cm (79 %), grade I-II (94 %), and hormone receptor positive (99 %) disease, with Ki-67 proliferation indices ≤10 % (54 %). All patients underwent surgery, 50 % received adjuvant radiation therapy, 6 % adjuvant chemotherapy, and 63 % adjuvant hormone therapy. Five-year RFS was 94 % with no identified clinicopathologic or treatment factors significantly affecting survival, including the presence of micropapillary features.

Conclusion

We report one of the more diverse single institution series of patients with PMBC based in the United States. This rare breast cancer subtype is associated with a favorable prognosis and may benefit from omission of aggressive standard treatment approaches.

Anorectal mucosal melanoma (AMM) is a rare and aggressive malignancy. Although treatment of AMM involves a multimodal approach, including surgical excision, chemotherapy, and immunotherapy, there is insufficient evidence to conclude any standardized protocol for treatment. Here we demonstrate a case of a 62-year-old female who presented with rectal bleeding and changes in bowel habits. A colonoscopy revealed a mass at the posterior dentate line, and a subsequent biopsy confirmed AMM. She underwent immunotherapy for 10 months, and by her 1-year follow-up, several surveillance studies remained negative for recurrence. While surgical excision with adjuvant therapy provides the most favorable prognosis, recent literature suggests immunotherapy as an effective treatment.1 This case highlights the treatment of AMM using immunotherapy as a neoadjuvant and maintenance therapy after surgical excision.

Extranodal Natural Killer (NK)/T-cell lymphoma, nasal type, is rare and frequently found in Asia and South America. It is rarely found in the United States, mainly in the immigrant population. We present a 26-year-old male from Central America who was found to have disseminated NK/T-cell lymphoma. Through this article, we explain how we manage our patient and try to consolidate the treatment modalities for different stages of the disease.

Mycosis fungoides (MF) is the most prevalent cutaneous T-cell lymphoma, with clinical symptoms comparable to erythroderma. An Indonesian female, 64-year-old, complained of itchy reddish skin and thick scales all over her body. She had a medical history of type 2 diabetes mellitus. Psoriasis vulgaris (erythroderma) was diagnosed and treated based on the signs and symptoms. The prognosis was not improved and a skin biopsy revealed mycosis fungoides (MF). Patient was treated with CHOP regiment, NB-UVB, and a combination of symptomatic therapies, which resulted in a favorable therapeutic response. Difficulties in diagnosis MF are caused by clinical signs and symptoms resembling dermatological disease. There is currently no cure for MF and the main purpose of treatment is illness management. Because the prognosis is poor at advance stage, an initial diagnosis and treatment are necessary to obtain a better prognosis.

Classic Hodgkin lymphoma rarely undergoes pathological transformation, and the transformation type is usually common non-Hodgkin lymphoma. This study describes a 71-year-old male diagnosed with stage III classic Hodgkin lymphoma positive for Epstein‒Barr virus. The disease was partially relieved soon after chemotherapy but quickly progressed with transformation into composite lymphoma with a mixture of T and B cells. Then he developed symptoms in his nervous system and was diagnosed with Guillain‒Barré syndrome. EBV remained positive throughout the course of the disease. Classic Hodgkin lymphoma may transform into composite lymphoma, and the composite lymphoma may be complicated with Guillain‒Barré syndrome after chemotherapy. We hypothesized that EBV infection may play a role in the progression of the disease.

Background

Lambert-Eaton myasthenic syndrome (LEMS) is an uncommon illness of the neuromuscular junction. It typically manifests as a combination of proximal muscular weakness, autonomic dysfunction, and areflexia. It is typically associated with small cell lung cancer. However, this paraneoplastic syndrome has been discovered in other clinical entities, such as multiple myeloma, which is a rare and infrequent occurrence.

Case presentation

We report the case of 54-year-old female with history of tobacco usage, who presented with generalized weakness. The patient underwent multiple tests, including blood work up, electromyography, and imaging. The laboratory results yielded high protein levels and anemia, which prompted clinicians to pursue SPEP work up that yielded an elevated M spike, establishing MGUS diagnosis. Neurology evaluation was done in the setting of worsening symptoms. Antibody testing was positive for voltage-gated calcium channels, establishing diagnosis for Lambert-Eaton Myasthenic Syndrome. She underwent prednisone, pyridostigmine and amifampridine treatment noticing symptom improvement. Months later lab work showed unchanged M spike, and bone marrow biopsy showed 10 % IgA plasma cells, establishing Multiple Myeloma. She was started on daratumumab, decadron, lenalidomide and later on stem cell transplantation with success.

Conclusions

Coexistence of LEMS with multiple myeloma is a clinical entity with few published occurrences, providing diagnostic and therapy challenges due to the limited knowledge known about the potential link between the two.