Current problems in cancer. Case reports最新文献

Breast cancer is the most common malignancy among women worldwide, often characterized by the uncontrolled proliferation of breast cells, leading to the formation of lumps or tumors that can be detected through medical imaging such as X-rays. Distinguishing between benign and malignant tumors presents a significant challenge in the diagnosis of breast cancer.

In this study, machine learning methods, including Logistic Regression, Gradient Boosting, Ada Boost, Random Forest, and Gaussian NB with Grid Search, were employed to differentiate between healthy individuals and those with malignancies. The results revealed that the Random Forest algorithm exhibited the highest performance in predicting breast cancer, accurately identifying 99 % of both healthy and affected individuals. Additionally, both Gradient Boosting and Ada Boost demonstrated a similar level of accuracy, correctly distinguishing 98 % of healthy and affected individuals.

Conversely, Gaussian NB performed the least effectively, with an accuracy of 91 % in differentiating between healthy and affected individuals, highlighting its comparatively lower predictive capability for breast cancer.

Immunotherapy has revolutionised cancer treatment over the past decade and is now well established in the management of a range of cancer primaries, including non-small cell lung cancer. Pembrolizumab acts as a checkpoint inhibitor through programmed death protein 1 (PD-1) inhibition. However, the use of immune checkpoint inhibitors can be complicated by immune-related adverse events (irAE). Neurological complications are rare but are associated with high morbidity compared to other irAE.

Here we report a rare case of bilateral optic neuritis following Pembrolizumab in a patient treated for metastatic lung adenocarcinoma. The patient had also received whole brain radiotherapy during the course of the treatment. Symptom onset occurred during maintenance treatment and at twelve months after first commencing systemic anticancer treatment. Fundoscopy demonstrated optic disc pallor with enhancement of the optic nerves and optic chiasm was seen on Magnetic Resonance Imaging. Symptoms were refractory to steroid treatment and resulted in chronic and profound visual impairment.

Noninvasive prenatal testing (NIPT) analyzes placental cell-free DNA in maternal blood for genetic abnormalities, especially in pregnant women of advanced maternal age. It is a high-sensitivity and specificity test used for screening fetal chromosome trisomy 13, 18, 21, sex chromosome aneuploidy, and rare fetal chromosome aneuploidy. Rarely there were cases in which it was used to diagnose maternal cancer. We will discuss a case of metastatic breast cancer diagnosed by NIPT and current knowledge on the use of this technology in diagnosing cancer during pregnancy.

Background

Hypereosinophilia, as defined by the absolute eosinophil count ≥ 1,500 cells per microliter, can be a consequence of primary (clonal) hematologic disorders or secondary response to inflammation from allergens, parasitic infections, medications or cancer. Its evaluation requires comprehensive history and physical as well as laboratory studies to identify the underlying cause and assess for evidence of end-organ damage in concern for hypereosinophilia syndrome. Here, we report a rare case of paraneoplastic hypereosinophilia with an absolute eosinophil count exceeding 70,000 cells per microliter in the setting of a newly diagnosed metastatic non-small cell lung cancer.

Case presentation

A 60-year-old Caucasian male smoker with past medical history of cerebrovascular accidents and heart failure with reduced ejection fraction presented with acute encephalopathy and later developed multi-system organ failure. Peripheral blood smear and other hematologic studies were not suggestive of clonal hematologic malignancy. Extensive infectious work-up of peripheral blood, lower respiratory tract and cerebrospinal fluid was negative. Review of recent medical record did not identify any potentially causative drugs. Diagnostic thoracentesis of the loculated pleural effusion showed poorly differentiated non-small cell lung cancer, which was deemed as the underlying etiology of his profound hypereosinophilia. His encephalopathy and other signs and symptoms of end organ damage were thought less likely to be directly driven by hypereosinophilia. Progressive critical illness unfortunately precluded disease-directed therapy and his family opted for comfort care to mitigate suffering.

Conclusions

Our case report highlights paraneoplastic etiology as an important diagnostic consideration in a patient with unexplained hypereosinophilia. Review of the literature shows that hypereosinophilia in patients with non-small cell lung cancer and other solid malignancies correlates with rapid disease progression and poor prognosis, though the underlying mechanisms remain unclear. Interestingly, case reports of hypereosinophilia in non-small cell lung cancer suggest a male-biased incidence. Investigation of the role of eosinophils in modulating anti-tumor immunity and its sex difference is warranted.

We report a case of synchronous bilateral orbital metastases from primary lobular breast cancer with the radiographic imaging features of a diffuse orbital soft tissue inflammatory process. A 77-year-old lady with a history of lobular breast cancer and bilateral quadrantectomy 15 years earlier was referred to our Ocular Oncology Unit. She complained about double vision and ocular pain. Through an ophthalmological examination, she presented significant bilateral proptosis and complete ophthalmoplegia. Magnetic resonance imaging showed a diffuse soft tissue infiltration of both orbits with mild T2w fat-sat hyperintensity and T1-isointensity relative to extra-ocular muscles and a diffuse involvement of both the intra- and extra-conal compartments. Significant enlargement of the extraocular muscles without sparing the muscle tendons and eyelids soft tissue swelling were also evident. Post-contrast images showed a diffuse and bilateral contrast enhancement of the involved tissues. Due to the inconclusive imaging findings, a bilateral orbital incisional biopsy was planned. The histopathological and immunohistochemical diagnosis was of lobular breast carcinoma and the patient underwent external beam radiotherapy with consistent clinical improvement. In conclusion, post-menopausal women presenting with a history of breast carcinoma and clinical and radiographic findings suggestive of acute bilateral orbital inflammatory disease should be biopsied to rule out metastatic disease even several years from the primary tumour.

The incidence of secondary monoclonal gammopathy of undetermined significance is limited in patients with multiple myeloma post chimeric antigen receptor T-cell therapy. This is a case of secondary monoclonal gammopathy of undetermined significance with the appearance of distinct paraprotein peaks demonstrating isotype switching from IgA lambda to IgG lambda within 6 months post autologous chimeric antigen receptor T-cell therapy in a 66 year old multiple myeloma patient. Secondary monoclonal gammopathy of undetermined significance with or without isotype switching and/or new paraprotein bands may be a rare but important example of a benign and transient phenomenon representing pseudo-disease progression and potentially associated with longer progression-free survival and better overall outcomes. Although such association remains speculative given paucity of literature and an absence of high-quality data.

Background

While cutaneous melanoma is common in up to 2.6% of Caucasian population, it is far less common in the African American population, up to 0.1%. Additionally, anal melanoma in particular comprises less than 1% of all melanomas and roughly 4% of anal cancers, while Spindle-cell variants are even less common, suggesting an extremely low incidence in the African American population. Definitive diagnosis can be challenging due to lack of definitive mass or pigmentation at presentation. There is a lack of good long-term studies and treatment guidelines for this malignancy with significant variation in treatment approaches and patient outcomes.

Case description

Here we present a case of an 63-year old African American gentleman with no significant past medical history and unremarkable colonoscopy 3 years prior, who presented with a mass in the anal canal that was found during a scheduled screening colonoscopy. The patient was completely asymptomatic at presentation. PET/CT scan showed hypermetabolic activity in the anal canal region. Patient underwent surgical excision with pathology revealing a 2.7 cm spindle cell type of malignant melanoma and promptly treated with adjuvant immunotherapy, resulting in extended progression-free survival before recurrence in the liver.

Conclusion

The early diagnosis of spindle cell melanoma can prompt more aggressive surgical and systemic management options resulting in extended survival, however, late recurrences are common and often refractory to standard therapeutic options.

This case series of 9 patients with NSCLC is the first to detail the presentation and treatment of ulcerative scalp lesions associated with amivantamab, a bispecific antibody which targets both epithelial growth factor receptor (EGFR) and mesenchymal-epithelial transition factor (MET). At our institution, 33 % of all patients on amivantamab develop scalp ulcerations, following a classic presentation of papulopustular eruption of the face and trunk (9/9), paronychia (9/9), and oral mucositis (7/9). The scalp lesions began as follicular pustules, progressing to vegetative ulcerative plaques within 23 weeks. Ulcerations were refractory to treatment despite trials of multiple systemic therapies, including prednisone, acitretin, cyclosporine, secukinumab, and oral antibiotics. Prednisone offered the most substantial benefit while topical wound care including dressings and washes such as ketoconazole proprionate, sodium sulfacetamide & sulfur soap, salicylic acid shampoo, and Coloplast®/Duoderm®/Aquacel® dressings provided symptomatic relief. One patient also developed granulomas on her vocal cords. More research on treatment and prevention is needed, as 6/9 patients stopped amivantamab due to their skin toxicities. Meanwhile, oncologists and dermatologists must collaborate to monitor toxicities, prepare patients for the possibility of scalp ulcerations, and provide symptomatic relief whenever possible.

Lymphoma rarely arises within the central nervous system and occurs most commonly in association with disseminated systemic disease. Primary epidural lymphomas of the spine are infrequently encountered and are usually high-grade, diffuse large B-cell lymphomas. Low-grade lymphomas arising in the spine are rarer than high-grades and are usually marginal zone lymphomas. While treatments for systemic high-grade lymphomas are well defined, treatment of low-grade lymphomas arising within the Dura or within the epidural space are less defined. We present two cases of primary spinal Dural- and epidural-based low-grade lymphomas diagnosed surgically and treated with local adjuvant radiation without chemotherapy. Both patients demonstrated excellent long term symptomatic and systemic disease control. We review the literature on epidural and Dural low-grade lymphomas to guide treatment of these rare lesions.

Single-agent melphalan remains the gold standard for conditioning chemotherapy prior to autologous stem cell transplantation (ASCT) in the multiple myeloma (MM) setting. Melphalan's distribution in the central nervous system (CNS) is limited which raises the question if single-agent melphalan is the ideal conditioning regimen for MM patients with extramedullary involvement in the CNS. Here we present two patients with MM and CNS involvement at baseline who safely received reduced-dose carmustine (300 mg/m²) and melphalan for conditioning chemotherapy prior to ASCT. While this combination has been studied previously, no studies to our knowledge added carmustine to the preparative regimen explicitly for additive CNS penetration in patients with CNS involvement.