Possible Ovarian and Peritoneal Carcinoma Presenting in a Mediastinal Lymph Node and Pleural Effusion: A Case Report and Review of the Literature.

Ovarian carcinoma often doesn't show noticeable symptoms and is frequently diagnosed at an advanced stage. It is the most fatal cancer within the gynecologic system. Our understanding of ovarian pathology is limited, necessitating the use of multiple markers to accurately detect ovarian cancer, particularly when it presents abnormally, such as in pleural effusion or lymph nodes. A 45-year-old woman presented to the emergency room (ER) due to abdominal pain lasting for two weeks. A computed tomography (CT) scan revealed peritoneal carcinomatosis accompanied by ascites and calcification in the lymph nodes. The likely primary sources were determined to be mucinous adenocarcinomas from either the colon or ovary. Following the CT findings, a fine needle aspiration was conducted on a perigastric lymph node. Histopathology results indicated a "poorly differentiated carcinoma [with] malignant cells present." Subsequently, a PowerPort was inserted, and adjuvant chemotherapy commenced two days later, utilizing a combination of carboplatin, bevacizumab, and paclitaxel. Paracentesis was performed, yielding clear-yellow fluid. However, abdominal fullness gradually increased again after paracentesis. The patient began experiencing more intense abdominal pain, particularly in the left lower quadrant. Surgical exploration revealed widespread disease involvement throughout the intestines. Our patient exhibited an atypical manifestation of ovarian carcinoma, challenging its identification due to ectopic foci and the absence of many distinctly identifiable markers. Through comprehensive testing and a process of elimination, we successfully differentiated ovarian carcinoma from other potential cancers. The conclusive histopathological report, along with a markedly elevated CA-125 level, provided substantial support for the probable final diagnosis of ovarian carcinoma. Despite numerous advancements in staining and identification techniques, the diagnosis of ovarian carcinoma remains inadequately understood. Identifying ovarian carcinoma without clear visualization is often challenging, and further research is warranted to enhance our understanding of pathological methods. Moreover, there is a need to prioritize the development and exploration of ovarian carcinoma screening and testing methods to prevent delayed disease detection.

COVID-19 Vaccination in Pregnant Women: Exploring Serious Adverse Events.

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Unusual presentation of gastric cancer during treatment of hairy cell leukemia: Exploring the etiological basis of this rare phenomenon.

Hairy cell leukemia (HCL) is a rare B-cell lymphoproliferative disorder. Patients typically present with cytopenia and splenomegaly. We describe the case of a 78-year-old patient with refractory HCL who acutely developed a cystic lesion on the back while receiving moxetumomab pasudotox therapy. Biopsy of the lesion revealed the presence of adenocarcinoma, which prompted a detailed evaluation resulting in a diagnosis of stage IV gastric cancer. Nevertheless, to establish any association between moxetumomab pasudotox therapy and secondary cancer development, a satisfactory number of studies need to be conducted.

Pembrolizumab-Induced Lichen Planus in a Patient With Non-Small-Cell Lung Carcinoma (NSCLC) That Correlates to Therapeutic Response.

Immune checkpoint inhibitors are increasingly being used in the treatment of various solid organ and hematologic malignancies. Dermatologic toxicities associated with programmed cell death protein-1 (PD-1) and programmed death ligand-1 (PD-L1) therapy have been widely reported in the literature. Lichen planus is an inflammatory disease frequently seen in areas of the skin and oral mucous membrane lining. This autoimmune disorder is T-cell mediated with multiple contributing factors like emotional stress, genetic predisposition, isotopic response, or drugs. With increasing use of immunotherapy, early recognition and prompt treatment of associated adverse events are critical to ensure patient safety. Cutaneous toxicities are among the most commonly observed adverse events with this class of drugs. Here, we report a case of lichen planus in a 66-year-old male patient receiving pembrolizumab for stage IV non-small cell lung cancer (NSCLC). He was diagnosed 56 months ago with advanced lung cancer with brain metastasis. He has received 62 cycles of pembrolizumab and continues to be in complete clinical and radiographic remission. Pembrolizumab is a drug that helps immune cells in killing cancer cells by binding to the PD-1 protein. This case highlights the potential cutaneous side effects that may result in a patient with pembrolizumab and the fact that it can serve as a "clinical biomarker" and show therapeutic effectiveness of the treatment.

Recurrence Risk of Renal Cell Carcinoma Lingers Even Decades After Nephrectomy.

Renal cell carcinoma (RCC) is a common malignancy in elderly males. Metastatic spread of this cancer is not an uncommon occurrence, even after nephrectomy. Lung, bone, liver, and brain are the most frequently involved sites. Such a type of presentation mostly occurs within five years after nephrectomy however, cases have been reported later as well. Here, we report a case of metastatic renal cell carcinoma that presented in the form of a lung growth 28 years after nephrectomy. This highlights the importance to consider relapsed metastatic renal cancer in the differential, even decades after its surgical removal.

Ischemic Stroke in a Young Man: Unraveling the Domain of Myeloproliferative Disorders.

Ischemic stroke is a rare phenomenon in young adults. A complete workup for hypercoagulable and myeloproliferative disorders is a cornerstone of evaluation. Essential thrombocytosis is a chronic myeloproliferative disorder that primarily involves platelets. It may remain undiagnosed in patients and subsequently present in the form of ischemic stroke. The management of this disorder is complex and often involves cytoreduction therapies. The initiation of these drugs in such patients may lead to unnecessary adverse effects and complications. This case report is an attempt to highlight an underappreciated cause of stroke when assessing young individuals.

Correlation among [18F]fluorodeoxyglucose positron emission tomography/computed tomography, cancer antigen 27.29, and circulating tumor cell testing in metastatic breast cancer.

BACKGROUND: Tumor marker cancer antigen (CA) 27.29 and combined [18F]-fluorodeoxyglucose positron emission tomography (PET)/computed tomography (CT) scans are used to follow up response to treatment and disease progression in patients with metastatic breast cancer (MBC). Recently, circulating tumor cell testing (CTC) has been used in this context. It is not known if 1 of the 3 tests can be a surrogate for another. PATIENTS AND METHODS: We analyzed a database of 35 patients with MBC. There were 173 time points (> or = 6 weeks apart) when > or = 2 of these tests were performed. Correlation among all the 3 tests was statistically analyzed. RESULTS: Results of PET/CT scans were compared with CA 27.29 at 163 time points. There was a statistically significant correlation between both groups (P = .02); however, sensitivity of CA 27.29 to detect metastatic disease observed on PET/CT scan was 59%. The results of PET/CT scans were compared with CTC at 93 events, where there was a statistically significant correlation between both groups (P = .0002); however, sensitivity of CTC to detect metastatic disease shown on PET/CT scans was 55%. Cancer antigen 27.29 results were also compared to CTC at 100 events, where there was a statistically significant correlation between both groups (P = .0002). However, only 64% of patients with high CA 27.29 had abnormal CTC. CONCLUSION: Our data shows correlation among PET/CT scan, CA 27.29, and CTC. However, both CA 27.29 and CTC had poor sensitivity and negative predictive value to detect metastatic disease observed on PET/CT scan. Normal CA 27.29 testing or CTC has to be interpreted cautiously in patients with MBC.

Cancer health disparities among Indian and Pakistani immigrants in the United States: a Surveillance, Epidemiology, and End Results-based study from 1988 to 2003.

BACKGROUND: Immigrants from India and Pakistan comprise about 1.5% of the total United States population. To the author' knowledge, this is the first study analyzing epidemiologic data on Indian and Pakistani patients with newly diagnosed cancer. METHODS: The Surveillance, Epidemiology, and End Results (SEER) database has reported cancer incidence from 1973 to 2003. Since 1988, the Indian and Pakistani population has been reported separately under race and ethnicity. Frequency and survival analyses with SEER data were performed, and descriptive parameters were calculated along with overall survival in common cancers. RESULTS: In total, 6889 cases were reported between 1988 and 2003, and those cases included 51% men and 49% women (P = .821). Among men, 30% of cases were prostate cancers, 10% of cases were lung cancers, and 9% of cases were colorectal cancers. Among women, 38% of cases were breast cancers, 15% of cases were genital cancers, and 7% of cases were colorectal cancers. When overall survival with common cancer was compared between immigrants and non-Hispanic whites in the United States, it was better among Indian and Pakistani immigrants. CONCLUSIONS: In a United States-based Indian and Pakistani population, prostate and breast cancers were the most common malignancies in men and women, respectively. This differed from the incidence in India and Pakistan, where oral cavity cancer in men and breast and cervical cancers in women were the most common. These immigrant cancer patients also had better survival. This change in demographics may be attributed to multiple factors, and the current data have implications on cancer screening and intervention.

Thymic hyperplasia after adjuvant chemotherapy in breast cancer.

We report 2 patients with breast cancer who were treated with surgery and adjuvant chemotherapy for stage IIa and stage I breast cancers. Follow-up CT scans showed an anterior mediastinal mass, raising concern for tumor recurrence. Thymectomy performed on the first patient, and close follow-up with radiographic studies on the second patient, revealed benign thymic enlargement. Thymic hyperplasia can occur after cytotoxic chemotherapy and may be due to rebound enlargement after initial atrophy caused by chemotherapy. Thymic hyperplasia after chemotherapy has been reported mostly in young age groups and is described in the literature to be associated with various types of cancers, including lymphomas, leukemias, testicular cancer, and sarcomas, and in the stem cell transplant setting. This is the first case series describing 2 patients with early stage breast cancer who, following adjuvant standard dose chemotherapy, developed thymic hyperplasia. Awareness of this unusual side effect in patients treated with chemotherapy may prevent unnecessary investigation and surgical intervention.

Perioperative management of a patient with May-Hegglin anomaly requiring craniotomy.

May-Hegglin anomaly (MHA) is a rare type of autosomal dominant platelet disorder associated with mutations in the gene encoding nonmuscle myosin heavy chain 9 (MYH9). It is characterized by the presence of large platelets, leukocyte inclusions, and thrombocytopenia. The bleeding tendency is usually mild, but severe hemorrhages have been reported. This is the first reported case of a patient with MHA who underwent craniotomy for intractable seizure disorder of temporal lobe origin. Patients who have thrombocytopenia have a higher likelihood of developing intraoperative or postoperative intracranial hematoma and bleeding complications. The patient was administered desmopressin (DDAVP) prior to the neurosurgical procedure and had no complications. With this approach, the use of platelet concentrates could be avoided. We discuss the role of DDAVP in MHA and related platelet disorders and review the current literature.

Rhabdomyolysis and renal failure associated with gemfibrozil monotherapy.

OBJECTIVE: To report a case of rhabdomyolysis and acute renal failure associated with gemfibrozil monotherapy of hyperlipidemia. CASE SUMMARY: A 30-year-old white man with hypertension, type 1 diabetes mellitus, and hyperlipidemia was hospitalized due to myalgias, nausea, and vomiting that began after he started working as a jackhammer operator 4 days previously. His medications were lisinopril, aspirin, insulin, and gemfibrozil. Creatine kinase and creatinine, which previously had been mildly elevated and normal, respectively, were markedly elevated, consistent with rhabdomyolysis with acute renal failure. DISCUSSION: As of December 8, 2003, this is the only report of a patient with normal baseline creatinine level who developed rhabdomyolysis with acute renal failure associated with gemfibrozil monotherapy. Strenuous exertion, hypovolemia, and lisinopril use may have contributed to the severity of illness. An objective causality assessment revealed that an adverse drug reaction to gemfibrozil was possible. CONCLUSIONS: Gemfibrozil monotherapy of hyperlipidemia may predispose to rhabdomyolysis with acute renal failure. Patients using gemfibrozil should be cautioned regarding strenuous exertion, dehydration, and the need for prompt evaluation of myalgias.