Schwannomas Mimicking Leptomeningeal Spread in the Setting of Breast Cancer: A Case Report.

BACKGROUND: Breast cancer is currently the most diagnosed cancer globally. For patients who complete breast cancer treatment, developing a survivorship plan is important, including serial history, physical examinations, and annual mammograms to look for recurrence and metastasis. CASE REPORT: This is a case report of a 76-year-old female with a history of recurrent breast cancer who presented with lower-back pain and found to have MRI findings initially concerning for intradural extramedullary metastatic disease. Biopsy was later found to be consistent with benign spinal schwannomas. CONCLUSION: We present a unique case of spinal masses in the setting of breast cancer initially concerning for leptomeningeal spread, later found to have benign schwannomas that mimicked leptomeningeal spread on imaging. To our knowledge, this is the first reported case of schwannomas mimicking leptomeningeal spread in a patient with a history of recurrent breast cancer. After metastasis is excluded, schwannomas should be considered in the differential of benign spinal lesions.

A Rare Case of Bullous Pemphigoid Secondary to Checkpoint Inhibitor Immunotherapy: A Tense Situation.

Bullous pemphigoid is a serious and rare complication of immunotherapy. Here, we present a case of bullous pemphigoid secondary to ipilimumab/nivolumab checkpoint inhibitor therapy in a patient with metastatic melanoma. Immune checkpoint inhibitor therapy is more widely used now to treat cancer patients, bringing more challenging cases of adverse events associated with their use. Bullous pemphigoid can be a difficult diagnosis to make in the initial stages as the rash is similar to other red rashes before transforming into the typical appearance of a blister. As bullous pemphigoid can be a life-threatening adverse event, early identification is key to increasing patient survival.

Thrombotic Microangiopathy: A Rare Breast Cancer-associated Complication Treated Successfully With Doxorubicin and Cyclophosphamide.

BACKGROUND: Thrombotic microangiopathy (TMA) is a clinical syndrome consisting of hemolytic anemia, thrombocytopenia, and presence of schistocytes on peripheral blood smear secondary to disorders of systemic microvascular thrombosis. Malignancy-associated TMA is a rare entity and shares clinical features with that of HUS and TTP usually seen in patients with metastatic cancer, tumor cell infiltration of the bone marrow and/or response to cancer-directed therapy. CASE REPORT: We present a rare case of TMA secondary to breast cancer without evidence of bone marrow infiltration responsive to doxorubicin and cyclophosphamide treatment, after failed plasmapheresis with prednisone and later, eculizumab. CONCLUSION: Despite being a rare manifestation of metastatic carcinoma, early identification and treatment are essential to improving survival.

A Case of Allergic Bronchopulmonary Aspergillosis (ABPA) in a Patient with a History of Cocaine Use and Tuberculosis.

Aspergillosis refers to a spectrum of disorders that can occur due to colonization with the Aspergillus fungus. Allergic bronchopulmonary aspergillosis (ABPA) is an airway hypersensitivity reaction to the fungus that is almost exclusively seen in patients with cystic fibrosis or asthma. Here, we present a case of ABPA in a patient with a history of chronic cocaine use and tuberculosis and no history of asthma or cystic fibrosis. The patient had presented with progressively worsening dyspnea for three months as well as a 20-pound weight loss. Diagnosis was made with an elevated IgE against Aspergillus and chest CT findings, which included bronchiectasis and tree-in-bud nodular opacities. The patient was treated with IV methylprednisolone followed by a 4-day course of oral prednisone, with significant improvement. It is our hope to make healthcare providers aware of the potential presence of ABPA in chronic cocaine users and patients with tuberculosis, both of which are not traditionally associated with this condition.

Mir-206 regulates pulmonary artery smooth muscle cell proliferation and differentiation.

Pulmonary Arterial Hypertension (PAH) is a progressive devastating disease characterized by excessive proliferation of the Pulmonary Arterial Smooth Muscle Cells (PASMCs). Studies suggest that PAH and cancers share an apoptosis-resistant state featuring excessive cell proliferation. MicroRNA-206 (miR-206) is known to regulate proliferation and is implicated in various types of cancers. However, the role of miR-206 in PAH has not been studied. In this study, it is hypothesized that miR-206 could play a role in the proliferation of PASMCs. In the present study, the expression patterns of miR-206 were investigated in normal and hypertensive mouse PASMCs. The effects of miR-206 in modulating cell proliferation, apoptosis and smooth muscle cell markers in human pulmonary artery smooth muscle cells (hPASMCs) were investigated in vitro. miR-206 expression in mouse PASMCs was correlated with an increase in right ventricular systolic pressure. Reduction of miR-206 levels in hPASMCs causes increased proliferation and reduced apoptosis and these effects were reversed by the overexpression of miR-206. miR-206 over expression also increased the levels of smooth muscle cell differentiation markers α-smooth muscle actin and calponin implicating its importance in the differentiation of SMCs. miR-206 overexpression down regulated Notch-3 expression, which is key a factor in PAH development. These results suggest that miR-206 is a potential regulator of proliferation, apoptosis and differentiation of PASMCs, and that it could be used as a novel treatment strategy in PAH.