ABSTRACT
Paraneoplastic presentations are often the initial presenting symptom of a malignant process. A 15-year-old female presented with a progressively growing, sclerotic lesion of the neck restricting the range of motion. She was found to have bilateral ovarian tumors that proved to be diffuse large B-cell lymphoma (DLBCL). After starting cyclophosphamide, vincristine, and prednisone (COP), she had a rapid and complete resolution of the sclerotic lesion, as well as a favorable response to the neoplastic process. In this report, we present a very rare case of extranodal lymphoma associated with a paraneoplastic skin lesion.
ABSTRACT
Importance: Regular screening for diabetic retinopathy often is crucial for the health of patients with diabetes. However, many factors may be barriers to regular screening and associated with disparities in screening rates. Objective: To evaluate the associations between visiting an eye care practitioner for diabetic retinopathy screening and factors related to overall health and social determinants of health, including socioeconomic status and health care access and utilization. Design, Setting, and Participants: This retrospective cross-sectional study included adults aged 18 years or older with type 2 diabetes who answered survey questions in the All of Us Research Program, a national multicenter cohort of patients contributing electronic health records and survey data, who were enrolled from May 1, 2018, to July 1, 2022. Exposures: The associations between visiting an eye care practitioner and (1) demographic and socioeconomic factors and (2) responses to the Health Care Access and Utilization, Social Determinants of Health, and Overall Health surveys were investigated using univariable and multivariable logistic regressions. Main Outcome and Measures: The primary outcome was whether patients self-reported visiting an eye care practitioner in the past 12 months. The associations between visiting an eye care practitioner and demographic and socioeconomic factors and responses to the Health Care Access and Utilization, Social Determinants of Health, and Overall Health surveys in All of Us were investigated using univariable and multivariable logistic regression. Results: Of the 11â¯551 included participants (54.55% cisgender women; mean [SD] age, 64.71 [11.82] years), 7983 (69.11%) self-reported visiting an eye care practitioner in the past year. Individuals who thought practitioner concordance was somewhat or very important were less likely to have seen an eye care practitioner (somewhat important: adjusted odds ratio [AOR], 0.83 [95% CI, 0.74-0.93]; very important: AOR, 0.85 [95% CI, 0.76-0.95]). Compared with financially stable participants, individuals with food or housing insecurity were less likely to visit an eye care practitioner (food insecurity: AOR, 0.75 [95% CI, 0.61-0.91]; housing insecurity: AOR, 0.86 [95% CI, 0.75-0.98]). Individuals who reported fair mental health were less likely to visit an eye care practitioner than were those who reported good mental health (AOR, 0.84; 95% CI, 0.74-0.96). Conclusions and Relevance: This study found that food insecurity, housing insecurity, mental health concerns, and the perceived importance of practitioner concordance were associated with a lower likelihood of receiving eye care. Such findings highlight the self-reported barriers to seeking care and the importance of taking steps to promote health equity.
Subject(s)
Diabetes Mellitus, Type 2 , Diabetic Retinopathy , Population Health , Adult , Humans , Female , Middle Aged , Diabetic Retinopathy/diagnosis , Diabetic Retinopathy/epidemiology , Diabetic Retinopathy/complications , Diabetes Mellitus, Type 2/diagnosis , Diabetes Mellitus, Type 2/epidemiology , Diabetes Mellitus, Type 2/complications , Social Determinants of Health , Cross-Sectional Studies , Retrospective Studies , Health Promotion , Health Services AccessibilitySubject(s)
Acne Vulgaris , Darier Disease , Hair Diseases , Lymphoma , Polyomavirus Infections , Polyomavirus , Abnormalities, Multiple , Acne Vulgaris/complications , Child , Darier Disease/complications , Eyebrows/abnormalities , Hair Diseases/etiology , Hair Diseases/pathology , Humans , Lymphoma/complications , Polyomavirus Infections/complications , Polyomavirus Infections/pathologyABSTRACT
Vanishing bile duct syndrome is a rare paraneoplastic syndrome occasionally seen in pediatric Hodgkin lymphoma. It is usually regarded as a fatal disorder. Here, we present a case of vanishing bile duct syndrome cholestasis related to Hodgkin lymphoma that resolved after chemotherapy and radiation.
Subject(s)
Cholestasis , Hodgkin Disease , Paraneoplastic Syndromes , Antineoplastic Combined Chemotherapy Protocols/adverse effects , Bile Ducts/pathology , Child , Cholestasis/etiology , Hodgkin Disease/complications , Hodgkin Disease/drug therapy , Hodgkin Disease/pathology , Humans , Paraneoplastic Syndromes/drug therapy , Paraneoplastic Syndromes/etiologySubject(s)
Antineoplastic Agents , Gilbert Disease , Immunoconjugates , Brentuximab Vedotin , Humans , Ki-1 Antigen , MutationSubject(s)
Encephalitis , Ovarian Neoplasms , Teratoma , Adolescent , Encephalitis/diagnosis , Female , Humans , Ovarian Neoplasms/diagnosis , Teratoma/diagnosisABSTRACT
We describe 6 pediatric patients (12 to 18 y) with relapsed or refractory Hodgkin lymphoma treated with consolidative Brentuximab vedotin (Bv) following reinduction chemotherapy and autologous stem cell transplantation. The progression-free survival after autologous stem cell transplantation was 12, 18, 22, 24, 30, and 30 months. Most patients tolerated Bv well although 2 patients developed grade 3 neuropathy that prevent them from completing the scheduled 16 doses of Bv. Consolidative Bv in children and adolescents, as currently recommended for adult patients with early relapsed or refractory Hodgkin lymphoma, is feasible but with some significant toxicities.
Subject(s)
Antineoplastic Agents, Immunological/therapeutic use , Brentuximab Vedotin/therapeutic use , Hematopoietic Stem Cell Transplantation/methods , Hodgkin Disease/therapy , Neoplasm Recurrence, Local/therapy , Adolescent , Child , Combined Modality Therapy , Consolidation Chemotherapy , Female , Follow-Up Studies , Hodgkin Disease/pathology , Humans , Male , Neoplasm Recurrence, Local/pathology , PrognosisSubject(s)
Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Burkitt Lymphoma/drug therapy , Hair/abnormalities , Hirschsprung Disease/drug therapy , Immunity, Cellular/drug effects , Immunocompromised Host/drug effects , Osteochondrodysplasias/congenital , Primary Immunodeficiency Diseases/drug therapy , Adolescent , Burkitt Lymphoma/complications , Burkitt Lymphoma/immunology , Burkitt Lymphoma/pathology , Cyclophosphamide/administration & dosage , Doxorubicin/administration & dosage , Female , Hair/immunology , Hair/pathology , Hirschsprung Disease/complications , Hirschsprung Disease/immunology , Hirschsprung Disease/pathology , Humans , Methotrexate/administration & dosage , Osteochondrodysplasias/complications , Osteochondrodysplasias/drug therapy , Osteochondrodysplasias/immunology , Osteochondrodysplasias/pathology , Prednisone/administration & dosage , Primary Immunodeficiency Diseases/complications , Primary Immunodeficiency Diseases/immunology , Primary Immunodeficiency Diseases/pathology , Prognosis , Rituximab/administration & dosage , Vincristine/administration & dosageABSTRACT
PURPOSE: The implementation of a pediatric desensitization protocol specific to etoposide in an adolescent with Hodgkin lymphoma is described. SUMMARY: Etoposide is part of many chemotherapy regimens used to treat malignancies in children and adults, and it is also part of the backbone of many regimens used in clinical trials. Etoposide is known to produce hypersensitivity reactions during administration. Substitution with etoposide phosphate, which has less potential for hypersensitivity reactions, is used in place of etoposide after severe hypersensitivity reactions. Etoposide desensitization protocols (EDPs) have been reported in adult patients. CONCLUSION: The implementation of an etoposide desensitization protocol for pediatric patients is safe and helpful to prevent the elimination of etoposide from treatment protocols. The use of an EDP allowed the patient to remain on clinical trial and complete the prescribed treatment.
Subject(s)
Antineoplastic Agents, Phytogenic/therapeutic use , Desensitization, Immunologic , Etoposide/therapeutic use , Hodgkin Disease/drug therapy , Adolescent , Antineoplastic Agents, Phytogenic/administration & dosage , Antineoplastic Combined Chemotherapy Protocols , Child , Etoposide/administration & dosage , HumansABSTRACT
Juvenile nasopharyngeal angiofibroma (JNA) is a pathologically benign yet locally aggressive and destructive tumor that develops in the choana and nasopharynx. Historical treatment of JNA has included embolization, surgical resection, and radiation. Here, we describe three patients who received therapy with the mTOR inhibitor sirolimus with improvement in clinical symptoms, imaging, and overall well-being.
Subject(s)
Angiofibroma/drug therapy , Antibiotics, Antineoplastic/therapeutic use , Nasopharyngeal Neoplasms/drug therapy , Sirolimus/therapeutic use , Adolescent , Angiofibroma/pathology , Child , Humans , Male , Nasopharyngeal Neoplasms/pathology , Treatment OutcomeABSTRACT
We report here on a case of Ewing sarcoma (ES) occurring in a child with neurofibromatosis type 1. The sarcoma had an EWSR1-ERG translocation as well as loss of the remaining wild-type allele of NF1. Loss of the NF1 wild-type allele in the tumor suggests that activation of the Ras pathway contributed to its evolution. Review of available public data suggests that secondary mutations in the Ras pathway are found in â¼3% of ESs. This case suggests that Ras pathway activation may play a role in tumor progression in a subset of ESs.