Liver Metastasis of Thymoma: Case Report and Review of the Literature.

The 2021 "World Health Organization (WHO) Classification of Thoracic Tumours" classifies epithelial tumors of the thymus (thymomas) based on cytomorphology. Thymomas with benign cytomorphology are classified as type A, AB, B1, B2, and B3, while those with malignant cytomorphology are classified as thymic carcinoma. Although all thymomas have malignant potential, extra-thoracic metastasis of thymomas is exceedingly rare and the exact incidence is not known. Literature review demonstrated 39 cases of thymoma with extra-thoracic metastases reported since the publication of the 1999 WHO Classification of Thoracic Tumours. Nine of these cases presented with metastasis to the liver in the setting of concurrent metastasis to other organs, while only three cases metastasized solely to the liver. We herein report a well-documented case of type B1 thymoma with relatively limited stage (IIb) with an isolated, single liver metastasis occurring seven years after primary resection in a patient with concomitant myasthenia gravis. The following report includes a review of the literature, a discussion of thymoma classification and its relevance to prognosis, and an overview of other extra-thoracic metastatic thymoma cases.

Complete Response of High Microsatellite Instability Gastric Cancer and Synchronous Microsatellite Stability Rectal Cancer.

Gastric cancer, a leading cause of cancer-related death in the world, may occur with an additional synchronous malignancy in rare cases. Of these rare cases many are colorectal cancer. Microsatellite instability is a phenomenon that may contribute to the pathogenesis of both cancers, as are field cancerization and genetic susceptibility, although none of these explain many concurrent cases. In this case, we described a patient with locally advanced microsatellite instability-high gastric cancer and synchronous microsatellite stable rectal cancer, who received a combination chemo-immunotherapy regimen and achieved complete response. This report reflects on current knowledge surrounding synchronous primary malignancies and achieving complete response.

Disparities in esophageal cancer care based on race: a National Cancer Database analysis.

Esophageal cancer is one of the most common cancer killers in our country. The effects of racial disparities on care for esophageal cancer patients are incompletely understood. Using the National Cancer Database, we investigated racial disparities in treatment and outcome of esophageal cancer patients. The National Cancer Database was queried from 2004 to 2017. Logistic regression and survival analysis were used to determine racial differences in access, treatment and outcome. A total of 127,098 patients were included. All minority groups were more likely to be diagnosed at advanced stages versus Caucasians after adjusting for covariates (African American OR-1.64 [95% confidence interval 1.53-1.76], Hispanic OR-1.19 [1.08-1.32], Asian OR-1.78 [1.55-2.06]). After adjustment, all minorities were less likely at every stage to receive surgery. Despite these disparities, Hispanics and Asians had improved survival compared with Caucasians. African Americans had worse survival. Racial disparities for receiving surgery were present in both academic and community institutions, and at high-volume and low-volume institutions. Surgery partially mediated the survival difference between African Americans and Caucasians (HR-1.13 [1.10-1.16] and HR-1.04 [1.02-1.07], without and with adjustment of surgery).There are racial disparities in the treatment of esophageal cancer. Despite these disparities, Hispanics and Asians have improved overall survival versus Caucasians. African Americans have the worst overall survival. Racial disparities likely affect outcome in esophageal cancer. But other factors, such as epigenetics and tumor biology, may correlate more strongly with outcome for patients with esophageal cancer.

Clinical Characteristics and Outcomes in Immune Checkpoint Inhibitor Therapy-Associated Myocarditis.

Immune checkpoint inhibitor (ICI) therapy has played an important role in the treatment of several groups of cancers. Although a life prolonging treatment, many side effects have been shown with ICI therapy. This study looked at individual level clinical characteristics and outcomes with ICI therapy in patients who developed ICI-related myocarditis. A comprehensive review of the National Library of Medicine PubMed database was performed. Inclusion criteria were all studies that were composed of case reports and case series of individual patients undergoing ICI therapy that developed myocarditis. To appreciate individual patient level data, observational studies, clinical trials, systematic reviews, and meta-analyses were excluded. Our search yielded 333 results with 71 cases reviewed of ICI therapy-related myocarditis. The findings included an average age of 68 years, higher incidence in men, and pretreatment cardiac history of hypertension. Melanoma was the most prevalent malignancy with nivolumab being the most used ICI therapy. Heart failure was the most prevalent adverse event that was co-prevalent with myocarditis. Corticosteroid therapy alone was the most utilized therapy to treat ICI-related myocarditis. Mortality was seen in nearly half of the patient population. Our study reviewed the preexisting literature of prior reported myocarditis secondary to ICI therapy. Periodic surveillance should be performed by the cardio-oncologist and internist. Due to the expanding role of ICI therapy in treating a variety of cancer patients, appreciation of its impact on the development of myocarditis is needed.

Early Onset Neutropenia due to Rituximab Therapy in Mantle Cell Lymphoma: A Case Report.

Cases of late onset neutropenia (LON) after rituximab therapy have been documented, but few cases have been documented of early onset neutropenia (EON). We present a case report of a patient with mantle cell lymphoma who presented with EON, only 6 days after initiation of rituximab therapy, notable for the shortest duration to EON ever reported in literature. Throughout this paper, we explore the potential pathogenesis and incidence of EON with the help of our unique case.

CD5+ Diffuse Large B-Cell Lymphoma With Leukemic Transformation: A Rare Case With Central Nervous System Involvement, Treated With R-CHOP and Intrathecal Methotrexate/Cytarabine.

Diffuse large B-cell lymphoma (DLBCL) is one of several subtypes of non-Hodgkin's lymphoma, and one that can present in a myriad of ways. One unique and particularly aggressive presentation is leukemic transformation with CD5 positivity, which leads to systemic symptoms, a relatively high peripheral tumor load, and higher rates of CNS involvement. The prevalence of leukemic transformation has not been determined, as published literature is limited to case reports and small case series. CD5 positivity appears to be even rarer and is only found in a small fraction of DLBCL with leukemic transformation. Treatment regimens for this presentation have not been well-established due to the rarity of the disease and paucity of literature on the subject. Our patient, a 76-year-old female with a history of previously treated stage IIIB follicular lymphoma, was found to have CD5+ DLBCL with leukemic transformation. She was treated with rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) along with intrathecal methotrexate (IT MTX)/cytarabine after CNS involvement was diagnosed. The patient tolerated therapy well, with an objective reduction in leukocytosis and blast count. To our knowledge, this is the first such case of CD5+ DLBCL with leukemic transformation treated with dose-reduced R-CHOP and IT MTX/cytarabine. Her response to therapy indicates that this regimen could be a viable option for the treatment of this exceedingly rare disease presentation.

Case of HER2neu+ Invasive Pleomorphic Lobular Carcinoma With Response to Conventional Neoadjuvant Chemotherapy: A Viable Option for an Exceedingly Rare Breast Cancer Type.

Invasive pleomorphic lobular carcinoma (IPLC) is an extremely rare form of breast cancer that accounts for less than 1% of all breast cancer cases. Due to this rarity, currently, there is a lack of an established standard of care for patients diagnosed with this form of breast cancer. In this case report, we present a 57-year-old female with a complex oncologic history diagnosed with clinical prognostic Stage IIA (ER 5%, PR 0%, HER2neu 3+) invasive pleomorphic lobular carcinoma of the left breast treated with neoadjuvant docetaxel, carboplatin, trastuzumab, and pertuzumab-based therapy (TCHP) followed by surgery. Surgical pathology revealed treatment-related changes with a definite response to neoadjuvant therapy. We report this case to highlight the response of this rare pathological entity to a standard neoadjuvant regimen such as docetaxel, carboplatin, trastuzumab, and pertuzumab.

An Advanced AIDS Patient With CD4 <20 and Plasmablastic Lymphoma Achieving Complete Response With the V-EPOCH Regimen.

Plasmablastic lymphoma (PBL) is a rare form of non-Hodgkin lymphoma that is highly aggressive and carries a poor prognosis. Although the standard chemotherapy choice for most diffuse large B-cell lymphomas (DLBCL) is R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone), subtypes of DLBCL such as PBL are less responsive to this treatment regimen. The preferred regimens for PBL include infusional EPOCH (etoposide, prednisone, vincristine, cyclophosphamide, and doxorubicin hydrochloride), HyperCVAD (cyclophosphamide, vincristine sulfate, doxorubicin hydrochloride, and dexamethasone), or CODOX-M/IVAC (cyclophosphamide, vincristine, doxorubicin, high-dose methotrexate/ifosfamide, etoposide, and high-dose cytarabine). Recent studies have begun to investigate the addition of other agents to these regimens to improve survival. This case report is about a patient with a history of advanced acquired immunodeficiency syndrome (AIDS) with a cluster of differentiation 4 (CD4) count <20 who had CD20 negative plasmablastic lymphoma and was successfully treated with the combination of bortezomib and dose-adjusted EPOCH (V-EPOCH) and intrathecal chemotherapy, achieving complete response with optimal tolerance. To our knowledge, this is the first case to demonstrate a complete response with V-EPOCH for PBL in advanced AIDS with CD4 <20. We aim to highlight the importance of standardizing effective chemotherapeutic approaches to this cancer entity and augment the effectiveness of V-EPOCH therapy in the literature review.

Oxaliplatin-induced Pulmonary Toxicity: A Rare but Serious Complication.

The FOLFOX regimen (oxaliplatin, leucovorin, and 5-fluorouracil) is FDA approved for use in patients with colorectal cancer and other gastrointestinal malignancies. The initial phase III randomized controlled trials that led to FDA approval of oxaliplatin with leucovorin and 5-fluorouracil showed a less than 1% incidence of pulmonary fibrosis and grade IV pulmonary toxicities. Here we describe two cases of pulmonary toxicity in patients with metastatic colorectal cancer treated with FOLFOX and briefly review the literature regarding oxaliplatin-induced pulmonary toxicity.

Neoadjuvant Radiation with Concurrent 5-FU Resulting in Complete Pathologic Response in Stage IIIB Squamous Cell Carcinoma of the Urethra.

Squamous cell carcinoma (SCC) of the urethra is a rare malignancy, comprising less than 1% of all malignancies. The annual age-adjusted incidence of urethral SCC is 4.3 per million in men and 1.5 per million in women. Due to the rarity of the disease, there are a limited number of prospective randomized controlled trials to evaluate the optimal management of locally advanced urethral SCC. Here, we present the case of a 47-year-old man with stage IIIB urethral squamous cell cancer that showed complete clinical and pathologic response to neoadjuvant chemoradiation with only 5-flurouracil after incomplete response to traditional chemotherapy with paclitaxel, ifosfamide, and cisplatin (TIP).

A Pedunculated Skin Lesion in a Case of Clear Cell Renal Carcinoma.

Clear cell type renal carcinoma accounts for about 80% of all renal cell carcinomas. We present a 39-year-old male with clear cell renal carcinoma of the right kidney, stage I: T1 b (5 cm) N0 M0, who developed cutaneous metastases in the right submandibular region 28 months after nephrectomy. Our case is unique as i) the patient with stage I cancer (at the time of nephrectomy) presented with an isolated cutaneous nodule in a location distant from the primary site; ii) cutaneous nodule developed while being treated with pazopanib for metastatic lesions in the lung and adrenal; and iii) nivolumab and ipilimumab combination therapy decreased the vascularity of the nodule though it did not halt the nodule growth. Physicians should be knowledgeable about this rare clinical entity and its varied presentation. Further studies are necessary to determine optimal treatment, as the current therapeutic agents for metastatic renal carcinoma might not be adequate for cutaneous metastasis.