Refractory Autoimmune Hematological Presentations of Undiagnosed Tuberculosis.

Four patients who presented with autoimmune cytopenias as the sole manifestation of undiagnosed tuberculosis are described here. These were refractory to conventional immunosuppressive therapy and responded dramatically to treatment of the infection. The potential association between tuberculosis and immune hematological conditions is highlighted. Literature is reviewed with respect to possible pathogenetic mechanisms. Clinicians need to be aware of this type of unusual presentation of tuberculosis and must consider this chronic bacterial infection as a potential cause for refractory cytopenias.

Drug-induced infiltrative lung disease with weekly paclitaxel in breast cancer: Case series.

Drug-induced infiltrative lung disease (DI-ILD) can be caused by chemotherapeutic agents, antibiotics, antiarrhythmic drugs, and immunosuppressive agents. Common chemotherapeutic drugs causing DI-ILD include bleomycin, mitomycin C, bis (2-chloroethyl)-l-nitrosourea, cyclophosphamide, busulfan, and methotrexate. Taxanes and trastuzumab are also associated with lung injury. Estimated incidence of paclitaxel-induced lung injury is 0.73%-12%. Although cases of paclitaxel-induced lung injury have been reported previously, we found only one published case report of fatal lung injury caused by paclitaxel use. We are reporting the largest case series of seven patients who developed paclitaxel-induced lung injury along with review of literature.

Does Interim PET Scan After 2 Cycles of ABVD Predict Outcome in Hodgkin Lymphoma? Real-World Evidence.

PURPOSE: Escalated BEACOPP (bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone) improves overall survival (OS) in patients with Hodgkin lymphoma (HL) relative to ABVD (doxorubicin, bleomycin, vinblastine, and dacarbazine) therapy. However, the associated higher cost and toxicity discourage clinicians from prescribing it. Identifying high-risk patients and administering escalated BEACOPP remains an effective strategy. We assessed the significance of interim positron emission tomography (iPET) scan after 2 cycles (iPET2) in identifying this high-risk subset. PATIENTS AND METHODS: This cohort study used secondary data from 12 tertiary care centers in South India gathered over 10 years (2008-2018). OS, event-free survival (EFS), determinants of EFS, and complete response (CR) in iPET2 were assessed. RESULTS: The study included 409 patients with HL (mean age, 34.5 years; male/female ratio, 1.4:1). The median duration of follow-up was 2.8 years. Of 409 patients, 63% underwent PET-based staging and 37% underwent computerized tomography (CT) staging. Stage IV (28.9%) and bone involvement (9.2%) were seen more often with PET than with CT staging (9.2% and 2%, respectively). Among 171 patients with iPET2 results, 24% did not achieve CR, and no factors were significantly associated. The 5-year EFS and OS rates of the entire cohort were 78% and 97%, respectively. The 5-year EFS and OS rates of patients with CR on iPET2 were 90% and 99%, respectively, whereas these were 65% and 100%, respectively, for patients not achieving CR. On univariable analysis, sex, stage, and iPET2 response significantly predicted inferior EFS. On multivariate analysis, only iPET2 response significantly predicted EFS (P < .000). CONCLUSION: Our study supports the use of PET for staging and iPET2 for response assessment. Nonachievement of CR on iPET2 indicates unfavorable outcome, and such patients may benefit from more intensive treatment.

Fanconi syndrome due to light chain proximal tubulopathy in a patient with multiple myeloma.

Fanconi syndrome (FS) in an adult patient is an unusual finding and it merits thorough evaluation. Paraproteinemias are one of the common etiologies in adult FS and need to be ruled out. Among the various forms of renal involvement in multiple myeloma, light chain proximal tubulopathy (LCPT) is the rarest. Usually, it causes proximal tubular dysfunction which is characterized by intracytoplasmic deposition of crystallized, mostly kappa monoclonal light chains in proximal tubules; however, glomerular crystal deposition is unusual. Herein, we are presenting a patient with renal dysfunction and FS. On evaluation, she was found to have multiple myeloma and renal biopsy showed LCPT with extensive crystal deposition in the proximal tubular epithelium along with crystal deposition in the glomerular capillary endothelium. The treatment of the underlying multiple myeloma caused remission of the FS.

Bilateral acute ptosis leading to the diagnosis of a presumed metastatic gastric adenocarcinoma.

We report the case of a 57 year old diabetic Indian male with no history of malignancy, who presented with severe bilateral upper lid acute aponeurotic ptosis, following intravitreal bevacizumab for diabetic retinopathy. Brain MRI revealed lesions in the vault of the skull, both superior recti and an intraorbital lesion on the lateral aspect of the right optic nerve. PET-CT revealed multiple metabolically active lesions in both the lobes of the liver, cervical vertebrae and in the lesser curvature of the stomach. A biopsy taken from the lesion in the lesser curvature of the stomach showed poorly differentiated adenocarcinoma. The patient was treated with palliative chemotherapy (Epirubicin, Oxaliplatin and Capecitabine), but had progressive disease after two cycles and died 8 weeks after diagnosis. Gastric carcinoma is a quiescent carcinoma wherein metastatic manifestations often lead to the diagnosis of the primary tumor.

Synchronous bilateral medullary carcinoma of breast: is it metastasis or second primary?

Bilateral breast cancer is a rare event accounting for 2-5% of all breast malignancies. A second tumor in contralateral breast may be either synchronous or metachronous lesion. Synchronous bilateral invasive ductal carcinoma is known but medullary carcinoma is rare. The etiology of bilateral breast cancer is uncertain and prognosis in these cases once thought to be poor but recent data suggest a similar survival compared to unilateral disease. We report a case of triple negative synchronous bilateral medullary carcinoma in a 38-year-old female who presented with lump in both the breasts for three months. Multidetector computed tomography breast scan revealed bilateral heterogeneously enhancing well-defined lesion in both the breasts. Fine needle aspiration cytology from both the breast lump was suggestive of malignancy. Patient underwent bilateral modified radical mastectomy with axillary clearance in a single sitting. Histopathology showed synchronous bilateral medullary carcinoma of breast with ER, PR and HER- 2/ neu negativity. Patient was treated with chemoradiation and she is on regular follow up for one year without any recurrence or metastasis.

Uncommon manifestations of Endocervical Malignant Mixed Mullerian Tumor with Incidental Bilateral Fallopian Tube Carcinoma.

A 43-year-old perimenopausal lady presented with bleeding per vagina and lower abdominal pain. On evaluation, she had cervical polyp, which expelled spontaneously during the per speculum examination. Histopathology revealed malignant mixed Mullerian tumor. Extended hysterectomy with salphingo oophorectomy was carried out, which showed bilateral fallopian tube carcinoma and leiomyoma uterus. The patient was treated with carboplatin regime and found to be disease-free for 1 year. This case presented because of a rare combination of the lesions.

Malignant ectomesenchymoma of the nasal cavity.

Malignant ectomesenchymomas are rare tumors. This tumor affects predominantly young children. Most common site is head and neck. A multi modality approach should be appropriate for this soft-tissue tumor. We present a 43 year old female with malignant ectomesenchymoma of the nasal cavity.

Clinical presentation and outcome of pediatric ovarian germ cell tumor: a study of 40 patients.

BACKGROUND: Germ cell tumor is a rare malignancy accounting for 3% of all pediatric tumors. They are highly curable malignancies. The aim of this study was to evaluate the clinical presentation, management, and outcome in this subset. METHODOLOGY: The study population included 40 patients with age less than 18 years at diagnosis. They were treated in Cancer Institute Chennai, India from 1990 to 2002. They were analyzed for the various clinical, pathologic presentations, and survival outcomes. Actuarial method was used to estimate the overall survival and relapse-free survival. RESULTS: The mean age of the study group was 14+2.7 years with most of the patients being postpubertal. The common histologies being mixed germ cell tumor (32%) and dysgerminoma (27%). Ten percent of patients presented with ovarian torsion. Sixty-two percent of patients presented in advanced stage. Fertility preservation surgery was possible in 70% of the patients. Relapses were seen in 25% of the patients. The median duration of follow-up was 7.5 years with a 5 years disease-free survival of 72.8% and overall survival of 94.9%. Most of the patients achieved a good quality of life with normal menstrual cycles. CONCLUSIONS: This study confirms an excellent outcome for girls with ovarian germ cell tumor, although majority of the patients presented in advanced stage. Patients with initial histology of Teratoma and Mixed germ cell tumor relapsed frequently. The mainstay of treatment being fertility preservation and cisplatin-based chemotherapy.