Oncoscience最新文献

Introduction: Vulvovaginal cysts are typically benign and asymptomatic, often going unnoticed during routine clinical evaluations. However, rare variants, such as vulvar mucinous cysts, can present atypically, sometimes mimicking more common lesions, like lipomas. Bartholin gland cysts, though common, may coexist with other unusual vulvar cysts, making accurate diagnosis essential for appropriate management.

Case report: A 36-year-old multiparous woman presented with lower abdominal and back pain, accompanied by a single episode of prolonged menstrual bleeding. On local examination, a soft, pedunculated, asymptomatic mass measuring 3 × 4 cm was observed on the left labia majora, clinically resembling a vulvar lipoma. In addition, multiple smaller, non-tender cystic lesions were noted along the inner surface of the left labia minora. Surgical excision of all lesions was performed. Histopathological evaluation identified the labial mass as a mucinous vulvar cyst and the smaller lesions as multiple Bartholin gland cysts, with no evidence of atypia. The postoperative course was uneventful, and the patient was discharged in stable condition with advice to follow up after the next menstrual cycle.

Conclusion: This case emphasizes the importance of considering rare vulvar mucinous cysts in the differential diagnosis of asymptomatic vulvar masses. Coexistence with multiple Bartholin cysts adds to the diagnostic complexity. Surgical excision not only provides a definitive diagnosis but also prevents future complications. Histopathological evaluation remains crucial for accurate classification and guiding follow-up.

Breast cancer (BC) is the most common malignancy in women. Both histology and immunochemistry are core to treatment choice and the knowledge of these fields is expanding. Metastatic breast cancer (MBC) has significantly lower overall survival (OS) than early stages, and leptomeningeal carcinomatosis (LMC) and brain metastasis (BM) have particularly worse prognosis. We describe a case of LMC BC treated with trastuzumab-deruxtecan (T-DXd). Thirty-seven years old woman, diagnosed with a HER2-positive invasive lobular carcinoma (cT2N0M0). After initial treatment with neoadjuvant chemotherapy plus anti-HER2 double blockade, surgery and postoperative radiotherapy, the patient relapsed with de novo LMC and BM, two years after initial diagnosis. Systemic therapy with first line off-label T-DXd was initiated, resulting in disease response, neurological recovery and improved quality of life (QoL). Disease complexity and expansion of new therapeutic options in BC has made multidisciplinary team discussion mandatory. In the HER2-positive MBC setting, antibody-drug conjugates (ADC), such as trastuzumab-emtansine and T-DXd, have shown important disease outcomes and QoL improvement. Equally important, these treatments are well tolerated and have manageable adverse events, making them safe and effective drugs. This solid evidence is seemingly leading into a new and groundbreaking BC treatment era.

Primary pancreatic Hodgkin lymphoma (PPL) is an exceptionally rare condition often misdiagnosed as pancreatic adenocarcinoma or pseudocyst. Early histopathological diagnosis is crucial for prognosis and appropriate chemotherapy. We report a case of a 50-year-old male presenting with low-grade fever, chills, abdominal pain, and 30-pound weight loss over 10 weeks. Examination revealed significant epigastric tenderness without icterus. Laboratory findings showed leukopenia (1.2K/UL), low absolute neutrophil count (238), hyperbilirubinemia, and elevated AST/ALT (185/165), with normal lipase and amylase. Imaging revealed a 4.7 × 5.1 × 6.6 cm solid heterogeneous pancreatic head mass with multiple prominent retroperitoneal, gastro-hepatic, para-aortic, and portacaval lymph nodes. Retroperitoneal lymph node biopsy confirmed nodular sclerosis Hodgkin lymphoma with positive CD15, CD30, MUM-1, and EBV stains. Bone marrow biopsy revealed lymphoma infiltration, prompting initiation of A+AVD (brentuximab vedotin, doxorubicin, vinblastine, dacarbazine) chemotherapy for stage IV disease based on Karnofsky Performance Status. Hodgkin lymphoma, a malignant B-cell neoplasm, constitutes 11% of lymphomas and is characterized by Reed-Sternberg cells. PPL is extremely rare, often mimicking pancreatic adenocarcinoma. Features such as absent pancreatic atrophy, tumor necrosis, calcification, and vascular invasion may aid differentiation. Treatment depends on disease stage, with early stage managed by ABVD (Adriamycin, Bleomycin sulfate, Vinblastine sulfate, Dacarbazine) chemotherapy and radiation, while advanced cases require extended A+AVD chemotherapy. PPL accounts for <2% of extra-nodal lymphomas but remains a potentially treatable entity. This case underscores the importance of obtaining tissue diagnosis in the setting of a pancreatic mass before embarking on definitive treatment.

Vascular tumors of intermediate malignancy occupy a perplexing space in oncology; too aggressive to be dismissed, yet too indolent to follow the predictable trajectory of high-grade sarcomas. Among them, epithelioid hemangioendothelioma (EHE) stands out for its rarity, histological subtlety, and unpredictable clinical course. Frequently, its bland cytology, low mitotic activity, and deceptively benign patterns obscure its malignant potential, leading to diagnostic uncertainty. In the present case, the diagnostic challenge was evident, as the lesion presented clinically as a subcutaneous swelling resembling a hematoma. Histopathological examination demonstrated polygonal endothelial cells with intracytoplasmic vacuoles containing erythrocytes indicative of a vascular origin. Definitive diagnosis was achieved through immunohistochemical confirmation, showing positivity for CD31, CD34, and FLI-1. This report aims to highlight the diagnostic nuances, potential for misinterpretation, and therapeutic dilemmas associated with EHE, thereby reinforcing the need for vigilance in evaluating seemingly "low-risk" atypical subcutaneous swellings.

Introduction: Male infertility is a growing public health concern, influenced by modifiable lifestyle factors and hormonal imbalances. However, limited data from India have evaluated their combined impact on semen quality and sperm DNA fragmentation (SDF).

Methods: This cross-sectional study included 278 men aged 21-50 years from a tertiary care centre. Semen analysis was performed according to the WHO's 6th edition guidelines. The SDF was evaluated using the Sperm Chromatin Dispersion (SCD) test. Lifestyle details, occupational exposures, and hormonal profiles (FSH, LH, testosterone, AMH, prolactin) were gathered through structured interviews and laboratory testing. Statistical analysis was conducted using SPSS, with p < 0.05 regarded as statistically significant.

Results: Men aged >40 years showed a significantly elevated SDF (p = 0.038), although no significant differences were observed in conventional semen parameters. Tobacco and alcohol use were strongly associated with reduced sperm concentration, motility, and morphology (p < 0.001). Alcohol use was also associated with an increased SDF (p = 0.023). Abnormal BMI was correlated with poorer semen quality and higher SDF (p < 0.001). Occupational heat exposure significantly contributed to elevated SDF levels (p = 0.013). Hormonal analysis showed that low testosterone and elevated prolactin levels were associated with abnormal semen profiles, whereas low AMH levels were significantly correlated with increased SDF (p = 0.011).

Conclusions: Lifestyle habits and hormonal imbalances significantly affect the fertility of men. Clinical evaluation should be integrated into infertility assessments and counselling.

Cancer-associated thromboembolism and Trousseau's syndrome, which are paraneoplastic hypercoagulable states, are significant yet frequently underrecognized causes of cryptogenic stroke. We report a 71-year-old male who presented with recurrent embolic strokes and systemic thrombosis, later diagnosed with metastatic colorectal adenocarcinoma. Despite extensive investigations, no initial cancer-related symptoms were noted, and the diagnosis was made retrospectively after supraclavicular lymph node biopsy. The patient exhibited multi-territory infarcts, deep vein thrombosis, and renal and splenic infarcts, highlighting the aggressive thrombotic potential of malignancy-associated stroke. This case highlights the importance of early consideration of occult malignancy in cryptogenic embolic events, supporting comprehensive oncologic evaluation for unexplained hypercoagulable states.

Adult fibrosarcoma is a rare and aggressive soft tissue malignancy originating from spindle-shaped fibroblasts, primarily affecting deep soft tissues in the extremities, trunk, head, and neck. Surgical resection with R0 margins remains the gold standard, with adjuvant radiation therapy recommended for large or high-grade tumors to reduce recurrence risk. Chemotherapy and immunotherapy play complementary roles in disease management, with emerging strategies targeting matrix metalloproteinases and tumor microenvironment interactions to enhance chemosensitivity and overcome drug resistance. Despite advances in treatment, prognosis remains poor due to the tumor's aggressive nature. However, early detection with complete surgical excision and multimodal therapies offer the best prospects for improved patient survival.

Background: Trophoblastic differentiation or beta-human chorionic gonadotropin (β-hCG) secretion in endometrial carcinoma has been associated with poorly differentiated and aggressive tumors; however, the evidence is largely inconclusive. The review aimed to explore the prognostic role of trophoblastic differentiation and β-hCG in non-trophoblastic, primary uterine corpus cancers.

Methodology: A comprehensive electronic search across databases was conducted for all cases of cancers of the uterine corpus that were either associated with elevated levels of β-hCG or showed evidence of trophoblastic differentiation upon microscopy or both. Cases of gestational choriocarcinoma, trophoblastic tumors, tumors other than uterine corpus, and those tumors of uterine corpus but not reporting β-hCG as a marker were excluded. Data regarding patients' clinic-demographic details, tumor characteristics, β-hCG levels at the time of presentation, and how these values change with treatment, its peak levels, the extent of loco-regional metastasis, details of treatment received, and case fatality were extracted and analysed statistically.

Results: A total of 35 case reports/case series with a total of 40 cases were included in the present review. The mean age at presentation was 57.75 ± 17.22 years. Nulliparity, obesity, hypertension, and diabetes were important risk factors. Post-menopausal or abnormal uterine bleeding was the commonest presenting complaint. Trophoblastic differentiation or β-hCG expression was found to be associated with high tumor grade, poor differentiation, and poor overall patient survival. The lung was the most common site of metastasis.

Conclusions: Trophoblastic differentiation or elaboration of β-hCG in cancers of the uterine corpus is a rarity, and the majority of them are associated with a grim prognosis, secondary to being associated with poor differentiation, early hematogenous dissemination, and resistance to chemo-radiotherapy. Measurement of pre-operative β-hCG may be considered in all cases of endometrial carcinomas and sarcomas, and if found elevated, immunohistochemical examination with β-hCG should be carried out.

Background: Burnout is an increasing concern in oncology, with significant implications for staff well-being and the quality of care delivery. This study aimed to determine the prevalence of burnout among oncology healthcare professionals in Morocco, primarily nurses and technicians, and to identify associated sociodemographic and occupational factors.

Materials and methods: A cross-sectional study was conducted from September to December 2024 at the National Institute of Oncology in Rabat. Ninety-one healthcare professionals completed the Maslach Burnout Inventory-Human Services Survey (MBI-HSS). Structural Equation Modeling (SEM) was used to explore the interrelationships among the three burnout dimensions.

Results: Severe burnout was identified in 61.5% of participants. Emotional exhaustion was the most affected dimension (70.4% moderate or high), followed by depersonalization (57.1%). While 50.5% reported high levels of personal accomplishment, 24.2% reported low fulfillment. Higher levels of burnout were associated with younger age, female gender, nursing roles, and night shift work. SEM analysis confirmed the central role of emotional exhaustion in predicting both increased depersonalization (β = 0.524, p = 0.002) and reduced personal accomplishment (β = -0.820, p = 0.003).

Discussion and conclusion: Burnout is highly prevalent among oncology healthcare professionals in Morocco, particularly among young female nurses. Key contributing factors include age, gender, level of seniority, and shift schedules. Participants emphasized the importance of reducing workload, improving working conditions, adjusting salaries, and promoting continuing education. Institutional interventions are urgently needed to address burnout and protect healthcare worker well-being.

Background: Non-gestational ovarian choriocarcinomas (NGOC) are rare, distinct, highly aggressive tumors, primarily affecting young women. It accounts for less than 0.6% of malignant ovarian germ cell tumors. It is associated with a poorer prognosis compared to gestational choriocarcinoma.

Case presentation: A 36-year-old woman (P2L2) presented with intermittent heavy menstrual bleeding for the past three months. The urinary pregnancy test was positive. On abdominal examination, a solid mass consistent with 20-weeks gravid uterus was palpated in right iliac fossa. Bimanual pelvic examination revealed uterus deviated to the left and large (~12 × 10 cm) predominantly solid mass arising from right adnexa, adherent to the uterus. A mobile cystic mass (6 × 5 cm) was palpated in the left fornix. Ultrasonography showed normal-sized uterus with no gestational sac and a well-defined, solid-cystic right adnexal mass (10.2 × 7.8 × 7.8 cm) with vascularized solid areas and hemorrhage, initially suggesting an ectopic pregnancy. Serum β-hCG was markedly elevated (262,809 mIU/mL; normal level <5.0 mIU/mL). Magnetic Resonance Imaging (MRI) and Contrast-enhanced Computed Tomography (CECT) revealed right ovarian germ cell tumor, likely choriocarcinoma, without evidence of metastatic disease. On staging laparotomy, hemorrhagic right tubo-ovarian mass (8.5 × 8 × 7 cm) and left ovarian serous cystadenoma (8 × 7 × 3.5 cm) were identified. Histopathology and genomic studies confirmed stage IA1 NGOC. Patient completed two cycles of adjuvant chemotherapy with Bleomycin, Etoposide, Cisplatin, achieving complete response (β-hCG <5 mIU/mL), and is following up with serial β-hCG monitoring and CT scans for two years.

Conclusions: NGOC closely mimics ectopic pregnancy and gestational trophoblastic disease and requires early diagnosis with prompt surgical and chemotherapeutic intervention to optimize outcomes.