Triple-negative breast cancer with calcified metastases of hepatic, portal vein and inferior vena cava: Report of a case and review of the literature.

Breast cancer frequently metastasizes to the liver and this usually bears a poor prognosis. Complete calcifications of hepatic, portal vein and inferior vena cava (IVC) metastases from breast cancer after systemic chemotherapy is extremely rare and to our knowledge, has never been reported. It is important for physicians to recognize the pattern and the formation of calcified liver metastases because the radiographic features of calcifications may assist in differentiating the etiologies of underlying malignancies and provide prognostic significance. We here presented such a case of triple negative breast cancer (TNBC) with calcified liver, portal vein and IVC metastases, and reviewed the literature.

Validation of the Taiwan Chinese version of the EORTC QLQ-CR29 to assess quality of life in colorectal cancer patients.

BACKGROUND: The increasing incidence of colorectal cancer in Taiwan has generated a need for a disease-specific quality-of-life measuring instrument. We aimed to validate the Taiwan Chinese version of the European Organisation for Research and Treatment of Cancer (EORTC) QLQ-C30 and QLQ-CR29. METHODS: A total of 108 patients were interviewed. Convergent and discriminant validity, Cronbach's alpha coefficient, test-retest reliability, and known-groups comparisons were used to examine the reliability and validity. RESULTS: We found good internal consistency reliability for multi-item scales of the QLQ-C30 and QLQ-CR29, except for the cognitive function and pain scale of the QLQ-C30. Patients in the active treatment group reported compromised functional scale scores (global health status/quality of life, QLQ-C30) and worse symptoms (blood and mucus in stool, QLQ-CR29) than those in the follow-up group. Similar results were found in comparisons based on Eastern Cooperative Oncology Group (ECOG) Performance Status and Bristol Stool Scale: higher physical function/sexual interest, less fatigue/urine frequency symptoms for patients with the lowest ECOG Performance Status (Grade 0), and borderline worse stool frequency scores from Types 5 and 6 patients on the Bristol Stool Scale. CONCLUSION: The study validated the Taiwan Chinese version of the EORTC QLQ-C30 and QLQ-CR29. The clinical applicability warrants further studies with greater number of participants.

Underestimation of the coexistence of iron deficiencies and thalassemia minors: a single institution experience in Taiwan.

Some physicians neglect the possible coexistence of an iron deficiency with a thalassemia minor and do not treat the iron deficiency accordingly. This motivated us to conduct this study. We retrospectively reviewed the records of 3892 patients who visited our clinics and had hemoglobin (Hb) electrophoreses performed in our hematologic laboratory from August 1, 2007 to December 31, 2012. The thalassemia minors were identified by characteristic complete blood count (CBC) parameters obtained from an autoanalyzer and Hb electrophoresis, and some cases were confirmed with molecular tests. Then, we checked iron studies [ferritin and/or serum iron with total iron-binding capacity (TIBC)] to determine the coexistence of an iron deficiency with a thalassemia minor and a response to iron, if such treatments were given. We found 792 cases with thalassemia minors, and excluded those without iron studies, with 661 cases as our sample. A total of 202/661 cases (31%) also had iron deficiencies. They had lower red blood cell (RBC) counts, Hb, and ferritin levels as compared to those thalassemia minor cases without coexistence of iron deficiencies. We concluded that the thalassemia minor patients did not have iron overload complications in our population. On the contrary, iron deficiencies commonly coexist in the clinical visits. We propose that if Hb < 11.5 g/dL in a case of thalassemia minor, one should screen for iron deficiency simultaneously. The sensitivity is 79.8% and the specificity is 82.6%. Therefore, physicians should be aware of this coexisting condition, and know how to recognize and treat it accordingly.

Prognostic value of platelet count in diffuse large B-cell lymphoma.

BACKGROUND: Besides International Prognostic Index, many parameters have proven prognostic significance in aggressive lymphoma. However, the most appropriate system of risk stratification in diffuse large B-cell lymphoma (DLBCL) is not yet clear. In this study, we attempt to clarify the prognostic value of platelet count at the onset of lymphoma. MATERIALS AND METHODS: Between January 2000 and December 2009, 100 patients with DLBCL receiving R-CEOP (rituximab, cyclophosphamide, epirubicin, vincristine, and prednisolone) in a single institution were enrolled. Patient characteristics and survival outcomes were retrospectively analyzed. RESULTS: Before front-line treatment, 17 patients with thrombocytopenia (< 150 × 10(9)/L) and 83 patients without thrombocytopenia were enrolled. Thrombocytopenic patients initially presented with more B symptoms (P = .040), more bone marrow involvement (P = .001), later staging (P = .001), and higher International Prognostic Index (P < .001). Thrombocytopenia was shown to be an independently poor prognostic factor in the multivariate analysis of overall survival (hazard ratio [HR], 3.405; 95% confidence interval [CI], 1.431-8.101; P = .006) and progression-free survival (HR, 4.299; 95% CI, 1.786-10.343; P = .001). CONCLUSION: Platelet count at diagnosis is a simple but useful indicator for predicting survival outcomes of DLBCL. Although the mechanisms of thrombocytopenia may be complex in lymphoma, further investigations are warranted to illustrate the predictive merit.

Myelodysplasia followed by Good's Syndrome: a unique manifestation associated with thymoma.

Good's syndrome, also known as thymoma with combined immunodeficiency, is rare. The immunodeficiency may precede, arise concurrently with or follow the diagnosis of thymoma. In addition to myasthenia gravis and Good's syndrome, paraneoplastic syndromes associated with thymoma can also be manifested with hematological disorders, such as pure red cell aplasia, aplastic anemia, agranulocytosis, hemolytic anemia, pernicious anemia, and paroxysmal nocturnal hemoglobinuria. Myelodysplastic syndrome is a group of clonal hematopoietic stem cell diseases characterized by cytopenia(s), dysplasia in one or more lineages, ineffective hematopoiesis, and potential precursors of acute leukemia. One proposed pathogenesis of myelodysplasia is autoantibodies that directly reject against hematopoietic cells, but this situation is rare in thymoma. Herein, we report a thymoma patient with unique paraneoplastic syndromes who developed myelodysplasia prior to Good's syndrome. Early and accurate diagnosis of myelodysplastic syndrome is important for disease management, especially in patients whose myelodysplastic syndrome is possibly derived from autoimmunity. For thymoma patients with recurrent infections, comprehensive immunologic studies to exclude the possibility of Good's syndrome and prophylactic intravenous immunoglobulin infusion in suitable candidates are warranted.

Nonmucosa-associated lymphoid tissue lymphomas of gastric and intestinal origin differ in their clinical features: a single institute experience.

BACKGROUND: The treatment policy and disease process of mucosa-associated lymphoid tissue (MALT) lymphomas are different from those of other gastrointestinal lymphomas. Chemotherapy has replaced curative surgery as the treatment of choice in gastric lymphomas but the optimal frontline treatment of intestinal lymphomas has yet to be defined. Hence, we attempted to identify the difference in features between gastric and intestinal nonMALT lymphomas. METHODS: Patients who were newly diagnosed with nonMALT lymphomas of gastrointestinal origin in our hospital between January 2001 and February 2010 were included in our study. Patient characteristics and outcomes were retrospectively analyzed. RESULTS: Among 59 gastric lymphoma patients and 25 intestinal lymphoma patients, the intestinal group were significantly younger and had better performance (p=0.002 and 0.042). Whereas gastrointestinal obstruction and intussusception were more common in the intestinal group (p=0.024 and 0.024), more bleeding episodes were displayed in the gastric counterpart (p=0.042). Histologically, diffuse large B-cell lymphoma was more prevalent in the stomach, and enteropathy associated T-cell lymphoma was found only in the intestine (p=0.006 and 0.024). Despite more intestinal lymphoma patients receiving surgery (p=0.002), the response rate, overall survival and progression-free survival were similar to the gastric counterpart (p=0.1060, 0.7758 and 0.1248). In the multivariate analysis of overall survival, chemotherapy (hazard ratio [HR] 0.2; 95% confidence interval [CI] 0.091-0.440; p<0.001) and International Prognostic Index (HR 1.7; 95% CI 1.181-2.448; p=0.004) proved prognostic in gastric lymphomas. Furthermore, T-cell lineage (HR 8.615; 95% CI 2.165-34.288; p=0.002) and poor performance (HR 9.374; 95% CI 1.497-58.712; p=0.017) were poor predictors in the intestinal counterpart. CONCLUSION: Intestinal lymphomas differ from gastric lymphomas in manifestation, histology, management and prognosis. Surgery still plays a role in intestinal lymphomas because presentations of surgical emergencies are more common. In addition, the outcome of gastric lymphomas compared with intestinal lymphomas is no longer superior if patients with MALT lymphomas are excluded. Because of the limited number of enrolled patients, further large-scale studies are warranted to validate these results.

Locally advanced female urethral adenocarcinoma of enteric origin: the role of adjuvant chemoradiation and brief review.

Primary female urethral adenocarcinoma (FUA) is rare and has a poor prognosis. The common manifestations include urethrorrhagia, urinary frequency, dysuria, urethral obstructions, focal tenderness, and urinary tract infection. These symptoms are neither diagnostic nor pathognomonic; therefore, a delay in diagnosis and even a misdiagnosis is hardly uncommon. The histogenesis of FUAs may have derived from urethritis glandularis, Mullerian ducts, Skene's glands, or mixed origins. Tumors of different embryologic origins displayed heterogeneous pathological morphology and immunohistochemistical phenotypes. Because of its rarity and the lack of large-scale studies, there is no current consensus on the optimal treatment of urethral adenocarcinomas. Here, we report two cases of locally advanced FUA of enteric origin. They manifested as slightest warning symptoms of urinary tract infection and stress urinary incontinence, respectively. One patient died of disease progression 2 months after curative operation. The other patient underwent surgery followed by adjuvant irinotecan-containing chemoradiation, and the effect was at least modest. Hence, we recommend adjuvant chemoradiation in locally advanced FUA. Individualizing cancer care of chemoregimens in accordance with the tumor origins may probably be beneficial in FUAs.

Diagnostic pitfalls of nonsecretory myeloma manifesting as multiple foci of periosseous plasmacytomas.

Nonsecretory myeloma, which comprises 1-5% of all myelomas, is a variant of plasma cell myeloma. It is defined as symptomatic myeloma without detectable monoclonal immunoglobulin levels on serum or urine immunofixation electrophoresis. Here, we report two cases of nonsecretory plasma cell myeloma that manifested as multi-foci periosseous plasmacytomas. Due to the inability to detect monoclonal immunoglobulin on serum or urine immunofixation electrophoresis and the lack of evidence of clonal plasma cells in the bone marrow, it was difficult to establish an early, accurate diagnosis. Misdiagnosing or mislabeling symptomatic myeloma patients with plasmacytoma results in the delay of their systemic treatment. Therefore, comprehensive imaging studies, the detection of free light chains, and histopathological confirmation from different sites and time points are necessary.

[The molecular epidemiologic investigation of hantavirus carried by rodent hosts in Wenzhou, Zhejiang province].

OBJECTIVE: To study the epidemiological features of hantavirus in rodents in Wenzhou, Zhejiang province. METHODS: Rodents were captured in Wenzhou, where hemorrhagic fever with renal syndrome (HFRS) had been endemic. Hantavirus antigens in the rat lungs were detected by immunofluorescence assay (IFA). Partial S segment (nt 620-999) and partial M segment (nt 2001-2301) sequences were amplified by RT-PCR, and then sequenced. Neighbor-joining method was used to construct for phylogenetic analysis. RESULTS: A total of 96 rodents were trapped in the epidemic areas, and 6 hantavirus antigens were identified from these lung samples (6.3%). Partial S and partial M segment sequences were successfully recovered from 5 samples and determined. Phylogenetic analysis of these sequences indicated that all viruses belonged to Seoul virus (SEOV), regardless of the sources (Rattus norvegicus, Rattus tanezumi and Rattus rattoide) that they were derived. However, the clustering pattern in the partial S-tree was different from that in the partial M-tree, suggesting that the re-assortment between SEOVs had occurred. CONCLUSION: All Rattus rats carried SEOV in Wenzhou and the genetic reassortment with SEOV had occurred naturally.