Primary mediastinal synovial sarcoma (PMSS) is an uncommon and aggressive soft tissue tumor, particularly rare in infants. Its diagnosis is challenging due to overlapping features with other thoracic neoplasms and requires integration of histopathology, immunohistochemistry, and molecular genetics. We present a case of a 4-month-old girl admitted with respiratory distress and found to have a large posterior mediastinal mass. Histopathology and immunohistochemistry were compatible with biphasic synovial sarcoma. However, molecular confirmation via detection of SS18-SSX fusion was not performed. Despite multimodal chemotherapy, the tumor progressed, and complete surgical resection was unachievable. The patient died during follow-up in the pediatric intensive care unit. Accurate diagnosis is critically dependent on SS18-SSX molecular testing, particularly in infants. Incomplete resection and lack of genetic confirmation may contribute to poor prognosis. Literature supports that complete resection is the only consistent predictor of survival. This case illustrates the limitations and consequences of managing PMSS without molecular confirmation or complete resection. A multidisciplinary approach with current diagnostic standards is essential in these high-risk pediatric tumors.
The combination of osimertinib and savolitinib as second-line treatment after epidermal growth factor receptor-tyrosine kinase inhibitor (EGFR-TKI) resistance can significantly improve median progression-free survival (mPFS), objective response rate (ORR), and duration of remission (DOR). The combination therapy is safe and controllable, with no new safety signals or unexpected toxicity. However, the mechanism of drug resistance for tumor progression after dual-targeted therapy is currently unclear, and there is no clinical data reference for treatment after drug resistance. This case suggests some treatment options for lung adenocarcinoma patient after dual-targeted therapy with osimertinib and savolitinib. A patient with EGFR -mutated lung adenocarcinoma developed mesenchymal–epithelial transition factor ( MET ) amplification-related resistance after first-line almonertinib. Subsequent sequential regimens—osimertinib plus savolitinib, chemo-immuno-antiangiogenesis therapy, and finally furmonertinib plus capmatinib—each yielded transient benefit. The report shows that the combination of chemotherapy and immunotherapy, as well as the dual-targeted therapy of firmonertinib and capmatinib, prolonged the overall survival of the patient. This case suggests some treatment options for lung adenocarcinoma patient after dual-targeted therapy with osimertinib and savolitinib. The results indicated that traditional treatment or the combination of MET-TKI with another targeted therapy may improve the prognosis of patients.
Hepatocellular carcinoma (HCC) is one of the deadliest cancer over the world. In this study, we aimed to determine the most critical molecular event in HCC patients with tumor protein p53 ( TP53 ) or catenin beta 1 ( CTNNB1 ) mutations, and to explore how these two mutations differ in their impact on HCC prognostication. We performed an integrated comparative analysis of exome and transcriptome data from The Cancer Genome Atlas (TCGA) for HCC patients. Patient prognosis and correlation with the immune infiltration characteristics were performed. HCC cell line based in vitro experiments were also performed to validate the mechanistic insights. The 3-year progression-free survival (PFS) analysis of HCC patients with TP53 mutations indicated a significantly poorer clinical outcome compared to those with CTNNB1 mutations. Functional annotation of the TP53 mutant cohort revealed a substantial upregulation of genes associated with immune regulation, while the CTNNB1 mutant cohort displayed a prominent activation of metabolic pathways. Further comparative analysis and in vitro experiments showed that TP53 missense mutations activated the signal transducer and activator of transcription 3 (STAT3) signaling pathway, which fostered neutrophil infiltration and enhanced the enrichment of regulatory T (Treg) cells by secreting specific inflammatory molecules in the tumor microenvironment. Notably, treatment with a an STAT3 inhibitor suppressed the expression of these inflammatory molecules, underscoring how an immunosuppressive tumor microenvironment in the TP53 mutant cohort contributes to a poor prognosis. Our study provides valuable insights, revealing that HCC patients with TP53 missense mutations exhibit a distinct immune profile associated with poorer clinical outcome compared to those with CTNNB1 mutations.
The purpose of this study was to assess clinical characteristics and survival of patients with advanced pancreatic cancer who were treated with gemcitabine, cisplatin, and 21-h infusional 5-fluorouracil (5-FU). This study was a prospective, observational study at a medical center in Western Iran. The clinical and survival data from 25 patients treated with gemcitabine, cisplatin, and 21-h infusional 5-FU at our center were prospectively assessed. Patients received chemotherapy consisting of cycles of continuous infusion of 5-FU (650 mg/m²) for 21 h on Days 1, 2, 3, and 4. Gemcitabine was administered at a dose of 1 g/m² on Days 1 and 8, and cisplatin was administered at a dose of 60 mg/m² on Day 1, with granulocyte colony-stimulating factor (G-CSF) support. Each cycle was repeated every 21 days for 5−6 cycles. A total of 25 patients with an age range of 39−73 years were studied. One out of the two patients with stage Ⅱ cancer survived for more than 43 months. Four out of the 14 patients with stage Ⅲ cancer survived for more than 15 months. Seventeen patients died, and eight subjects were alive at the end of the study. The mean and median of overall survival (OS) rates for the 25 patients were 20 and 12 months, respectively. The median progression-free survival (PFS) was 6 months. It seems that the triple therapy with gemcitabine, cisplatin, and infusional 5-FU afforded significant PFS and OS benefits in patients with advanced pancreatic cancer.
This study aimed to evaluate the effects of Xiaoyao San combined with Bazhen Decoction on insomnia in patients following breast cancer surgery. A total of 86 patients experiencing insomnia after breast cancer surgery were randomly assigned to either the treatment group or the control group. The treatment group received Xiaoyao San combined with Bazhen Decoction, while the control group was treated with estazolam tablets. The treatment duration was 4 weeks. Pittsburgh Sleep Quality Index (PSQI) scores were assessed before and after treatment. The overall efficacy and incidence of adverse reactions were compared between the two groups. PSQI scores in both groups significantly decreased after treatment ( p < 0.05). Total effective rate in the treatment group (93.02%) was higher than that in the control group (86.05%), although the difference was not statistically significant ( p > 0.05). The incidence of adverse reactions in the treatment group (4.65%) was significantly lower than that in the control group (20.93%) ( p < 0.05). Xiaoyao San combined with Bazhen Decoction can effectively improve sleep quality in patients with insomnia following breast cancer surgery, demonstrating good clinical efficacy and fewer adverse reactions. Further studies are needed to confirm these findings and explore broader clinical applications.
Tumor cavitation and pneumothorax are uncommon yet serious complications of antiangiogenic therapies. These risks are particularly significant in patients with metastatic renal cell carcinoma (mRCC). Axitinib, a selective inhibitor of vascular endothelial growth factor receptors (VEGFRs), is generally used as a second-line treatment for mRCC. However, rare cases of lung metastases with cavitary lesions and pneumothorax have been reported after the use of axitinib. Therefore, we decided to report one of these rare cases. A 46-year-old male with mRCC developed pleural cavitations and secondary pneumothorax after starting axitinib therapy. Despite intensive management, his condition worsened with recurrent pneumothorax, ultimately leading to sepsis and multiorgan failure. This case underscores the potential risks of tumor cavitation-induced pneumothorax in patients receiving axitinib. Close radiological monitoring and timely intervention are essential for reducing morbidity and mortality in such cases. Clinicians should remain vigilant for this rare but serious complication during axitinib therapy.
There is a paucity of real-world evidence in the Indian context to address the outcome of primary brain tumors (PBTs) in children. This study aimed to describe the demographic profile, clinical characteristics, and histological features of PBTs based on the 2016 World Health Organization classification, assess the efficacy of treatment methods, and identify the factors that influence the outcome. This is a single-institution, hospital-based study. Data were collected for pediatric patients aged 0−19 years, from September 2001 to May 2023 (22 years), who were diagnosed with malignant PBTs. Patients with radiologically or histologically proven tumors were included. Those with metastatic disease to the central nervous system were excluded. The overall survival (OS) and recurrence-free survival (RFS) were estimated using the Kaplan–Meier method. A total of 251 patients with pediatric brain tumors were included in this analysis. The mean age was 9.10 ± 5.54 years. The male-to-female ratio was 1.20:1. In this cohort, the most common histologies were medulloblastoma and astrocytoma. The mean survival of all patients with PBTs was 141.00 ± 7.90 months with 1-, 3-, and 8-year OS rates of 79.00%, 67.00%, and 60.00%, respectively. Medulloblastoma had 1-, 3-, and 8-year OS rates of 81.00%, 72.00%, and 65.00%, respectively. The 1-year OS rates for glioblastoma and brainstem glioma were 46.00% and 45.00%, respectively. Complete tumoral resection showed longer survival than lesser degrees of resection ( p = 0.001). Embryonal tumors (ETs) had a better RFS of 133.60 ± 12.70 months ( p ≤ 0.001). ETs have a better prognosis than glial tumors. With an improved OS, the surgical resection extent has a favorable outcome. As a chemosensitive tumor, medulloblastoma benefits most from systemic treatment and responds well to a multimodal approach.
Aromatase inhibitor-induced musculoskeletal symptoms (AIMSS), especially joint pain, have been widely reported in postmenopausal women undergoing endocrine therapy for hormone receptor-positive breast cancer and are a major cause of treatment termination. Aerobic exercise has emerged as a promising nonpharmacological intervention to counteract AIMSS in this population. This study aimed to perform a systematic review and meta-analysis to assess the effect of aerobic exercise on aromatase inhibitor-induced worst joint pain in postmenopausal breast cancer. A systematic literature search was performed using ClinicalTrials.gov, PubMed, and the Cochrane Library that yielded 1415 records. Studies comparing the effect of aerobic exercise with usual care on the worst joint pain through brief pain inventory (BPI) scoring in postmenopausal women with breast cancer receiving aromatase inhibitor therapy were included. For each group, the mean change from baseline and standard deviation (SD) of worst joint pain (BPI score) were calculated. Mean differences (MDs) with 95% confidence intervals (CIs) were pooled using a random-effects model. Subgroup analyses were conducted to explore heterogeneity based on exercise intervention. Three randomized controlled trials ( n = 297) were included. Pooled analysis showed no significant overall effect of exercise compared with control (standardized mean difference [SMD] = −0.16; 95% CI [−1.45, 1.14]; p = 0.65; I 2 = 74%). Subgroup analysis indicated a significant difference by exercise type ( p = 0.003), suggesting exercise modality influenced outcomes. Aerobic exercise, evaluated in two RCTs, significantly reduced worst joint pain (SMD = −0.41; 95% CI [−0.50, −0.32]; p = 0.01; I 2 = 0%), indicating consistent benefit across studies. In contrast, the single study assessing Nordic walking showed no significant improvement (SMD = 0.56; 95% CI [−0.08, 1.19]; p = 0.08). Risk-of-bias assessment revealed variability across studies, with one trial rated low risk, one with some concerns, and one at high risk, which may partly explain the observed heterogeneity ( I 2 = 74%). Aerobic exercise interventions did not show an overall significant effect on the worst joint pain. However, subgroup analysis revealed that multi-component aerobic exercise programs were associated with significant pain reduction, while the study with only Nordic walking intervention was not. Considering the clinical burden of aromatase inhibitor-induced musculoskeletal symptoms, aerobic exercise can be a potentially useful non-pharmacologic adjunct to endocrine therapy. However, given the variation in the assessed risk of bias among the included studies, these outcomes should be interpreted with due caution. To confirm these results and determine the optimal exercise type and duration for managing aromatase inhibitor–associated musculoskeletal symptoms in breast cancer survivors, further large-scale trials are necessary.
Breast cancer (BC) is the most prevalent and destructive tumor in developing countries. The implementation of mammography screening programs has enabled access to appropriate therapeutic interventions, including adjuvant endocrine therapy and breast‐conserving surgery; earlier diagnosis translates into a wider survival‐rate range, making hypofractionated radiotherapy (HFRT) the preferred option. This review examines the current literature comparing the two radiation therapies, HFRT and conventional radiotherapy (CR), with reconstructed breasts, focusing on efficacy, toxicity, cosmetic outcomes, quality of life (QOL), and cost‐effectiveness. A comprehensive literature search was conducted using major scientific databases, including PubMed, Scopus, Web of Science, and Google Scholar. The search focused on articles published primarily in English, from 2010 to 2024, and the period is about 15 years. The following search terms and Boolean operators were used: “hypofractionated radiotherapy” OR “hypofractionation” AND “breast cancer” AND “toxicity” OR “complications” OR “reconstruction” OR “quality of life” OR “HFRT versus CFRT” OR “intensity‐modulated radiation therapy” OR “proton therapy”. CR can be safely replaced with HFRT in terms of overall survival and local recurrence rates. HFRT is associated with lesser risks of both acute and chronic side effects, breast complications, increased patient satisfaction, and reduced breast problems. In addition, new radiotherapy modalities, such as intensity‐modulated radiation therapy, have shown great potential in targeting tumors. In treating BC, HFRT is gradually becoming standard, especially for patients who undergo reconstruction after surgery. Its low toxicity and equal effectiveness make it a key element in improving the QOL of BC survivors. It is recommended that future studies focus on long‐term outcomes to provide better care to patients.
Hepatocellular carcinoma (HCC) rupture and hemorrhage is one of the critical emergencies in HCC, with a high mortality rate upon occurrence. The mortality rate after rupture and hemorrhage is nearly 25%, while the recurrence rate of bleeding is approximately 20%, with a mortality rate exceeding 50%. Even after bleeding cessation, related complications pose significant challenges for treatment. Here, we report a case of multi-vessel rupture and hemorrhage in HCC, where initial hemostasis was successfully achieved via trans arterial embolization (TAE), but another vessel ruptured and bled again within 48 h. The total blood loss in this case was about 3300 mL, accompanied by severe complications such as infection, liver function deterioration, hepatic encephalopathy, and malnutrition. Additionally, we conducted a literature review on the mechanisms and treatment of HCC rupture and hemorrhage, aiming to provide insights and lessons for its diagnosis and management. (1) After TAE for ruptured hepatocellular carcinoma with hemorrhage, it is still necessary to be vigilant against the possibility of secondary hemorrhage. During the TAE procedure, precise embolization should be achieved as much as possible to reduce liver function damage. (2) After ruptured hepatocellular carcinoma with hemorrhage, complications such as abdominal infection, hepatic encephalopathy, malnutrition, and deterioration of liver function need to be watched out for. Early identification and active intervention can help patients achieve better prognosis.
Malignant bowel obstruction (MBO) is a highly morbid complication of advanced intra-abdominal malignancies. This study aims to identify clinicopathologic factors and intervention strategies associated with improved survival and reduced rates of re-obstruction. A single centre, retrospective data analysis was performed for all consecutive patients admitted with MBO to a tertiary cancer centre in Melbourne, Australia over a 2-year period. We identified a total of 102 patients with 137 admission episodes for MBO. Median age was 62 years, and 55 patients (54%) were female. 61 patients (60%) had a gastrointestinal primary (colorectal, gastric or appendiceal), while 17 patients (16%) had a gynaecological primary and 24 (24%) other primaries. Median overall survival was 120 days (95% confidence interval (CI) [76, 167]). 41 patients (40%) died within 90 days of initial admission with MBO. Clinicopathological variables associated with reduced 90-day survival included hypoalbuminaemia (odds ratio [OR] = 3.33 for serum albumin < 30 g/L, 95% CI [1.43, 7.69]) and peritoneal disease (OR = 5.80, 95% CI [2.26, 14.9]). 41 patients (40%) received surgical management. We identified no factors significantly associated with the decision for surgical rather than conservative management. Of the 113 total admissions that reached discharge, 55 (49%) were followed by patient readmission within 90 d. Almost half (48%) of patients were referred to the inpatient palliative care service and this was associated with a reduction in the odds of 90 d readmission (OR = 0.31, 95% CI [0.14, 0.71]). MBO heralds a poor prognosis, with high rates of readmission, morbidity and mortality. Careful patient selection is imperative to identify patients likely to benefit from operative management.
Sarcomatoid carcinoma is a rare and aggressive malignancy with a poor prognosis, capable of arising in diverse tissues. Pulmonary artery sarcomatoid carcinoma is particularly uncommon and highly invasive. We present the case of a 40-year-old male who experienced dry cough and dyspnea, and was subsequently diagnosed with a mass obstructing the bilateral main pulmonary artery, predominantly involving the left main branch shortly after contracting COVID-19. Histopathological analysis of a lung biopsy and positron emission tomography (PET) scan confirmed the diagnosis of sarcomatoid carcinoma involving the bilateral main pulmonary artery. Following six cycles of combined chemotherapy and immunotherapy, the patient's condition remained relatively stable. This case report aims to discuss the clinical presentation, diagnostic approach, and therapeutic management of this rare condition, thereby contributing to the broader understanding of sarcomatoid carcinoma.
Background: The Fn14 fibroblast growth factor-inducible 14(Fn14) can stimulate cell migration and promote cancer lessions. Progranulin(GP88)protein has been identified as an epidermal growth factor and participates in many biological processes. The aim of the present work was to investigate the immunohistochemical expression of Fn14 and GP88 proteins in relation to the clinical parameters in women's invasive ductal carcinoma(IDC) and to explore their role as novel prognostic biomarkers.Methods: The qualitative and quantitative immunohistochemical techniques were used to evaluate the expression levels of Fn14 and GP88 in 100 fresh samples of Egyptian women who had breast lesions. They were divided into three groups: control healthy tissues(10 samples from woman lesions), benign group(30 cases), and IDC group(60 cases).Results: The histopathological results of 60 cases with IDC have been reported with 45 cases being grade Ⅱ and 15 cases being grade Ⅲ. The immunohistochemical results showed that the degree of strong positive staining for both markers was increased in grade Ⅲ compared to that in grade Ⅱ. The integrated optical density was significantly increased in gradeⅢ(p < 0.05). Also, the result revealed a highly significant correlation between the two markers and the tumor size, grades, and lymph node metastasis, as well as a correlation to normal and benign breast lesions.Conclusion: The quantitative immunohistochemistry of Fn14 and GP88 proteins revealed the correlation between the two markers and clinical parameters. Therefore, the two markers may be serviceable as prognostic and therapeutic markers in IDC patients.
Background: Breast cancer is a major cause of mortality globally. Oncolytic virotherapy is a promising treatment modality that directly destroys cancer cells and induces an immune response against them. Among natural oncolytic viruses, Newcastle disease virus(NDV) has shown selective tumor cell infection.Materials and methods: In this study, we investigated the efficacy of variable doses of NDV and cyclophosphamide on 4T1 cancer cell line and BALB/c mouse tumors for the first time.Results: Compared with the control group, the combination treatment group with NDV and cyclophosphamide showed a significant increase in the expression levels of P21, P27, and P53 genes by 38%, 46%, and 81%,respectively(p < 0.05). In contrast, the expression levels of CD34, integrin α5, vascular endothelial growth factor(VEGF), and vascular endothelial growth factor receptor(VEGFR) genes significantly decreased by 47%,45%, 42%, and 23%, respectively(p < 0.05). The reactive oxygen species(ROS) generation assay evaluated with 2′,7′-dichlorodihydrofluorescein diacetate(DCFH-DA) staining showed a significant increase in ROS levels within 4T1 cells treated with NDV compared with the untreated group after 24 h(p < 0.01). Furthermore, Annexin V/propidium iodide(PI) double staining analysis showed that the proportion of apoptotic cells in the NDV-treated group decreased by 0.61% and 1.63% after 6 h and 12 h, respectively(p < 0.05). After 12 days, tumor volume in the NDV-treated groups decreased by 72%-87% compared with a 48% increase in the control group, reflecting a net reduction in tumor volume relative to the control group(p < 0.001).Conclusion: These findings demonstrate that NDV in combination with chemotherapy drugs may be a promising therapeutic option for cancer patients. However, several other factors need to be considered. These results indicate that NDV may have potential effects on cancer treatment.
Objective: This study aimed to evaluate the effects of graded motor imagery(GMI) on fear of movement, pain, and rehabilitation in patients with kinesiophobia after video-assisted thoracoscopic surgery(VATS) for lung cancer.Methods: Fifty-eight participants with kinesiophobia after VATS were randomly assigned into two groups: one receiving usual care(the control group) and the other receiving usual care plus GMI(the GMI group). The GMI was delivered in three stages: left/right limb identification, motor imagery, and mirror therapy delivered by two researchers every afternoon starting on the first postoperative day, once a day for about 40 min, at least twice. Level of fear of movement, pain-related patient-reported outcomes(PROs), rehabilitation exercise participation, and peak expiratory flow(PEF)were compared between the two groups.Results: Twenty-seven eligible participants were included in the GMI group and 29 in the control group. Compared to the reports on the first postoperative day, the participants who received GMI reported at discharge significant reductions in kinesiophobia, intensity of worst pain and least pain, and interference of pain with activities and emotions, and increases in rehabilitation exercise participation and PEF than those in the control group(p < 0.05). An unexpected finding was a reduced surgery-to-discharge interval in the patients who received GMI(almost a day earlier than those in the control group).Conclusion: GMI can reduce fear of movement, improve pain-related PROs, and increase rehabilitation exercise participation and PEF for lung cancer patients with kinesiophobia after VATS.The study was registered at the Chinese Clinical Trial Registry(ChiCTR2300072612).
Background: Breast cancer is one of the most common malignant tumors among women worldwide. Chemotherapeutic and targeted agents, as important adjuvant therapy for breast cancer, can also cause cardiotoxicity, leading to cardiac dysfunction. It is essential to recognize cardiotoxicity early, cease drug exposure when appropriate, and initiate heart failure therapy. Currently, echocardiography is routinely used to monitor cardiac function during treatment. However, normal left ventricular ejection fraction (LVEF) measured by echocardiography cannot exclude cardiotoxicity. Therefore, more sensitive cardiac monitoring tools are needed. Optical pumped magnetometer-magnetocardiography (OPM-MCG) has been proved to be a noninvasive and effective means to detect and monitor myocardial injury. Case description: In this case, we presented a patient diagnosed with early breast cancer with human epidermal growth factor receptor 2 (HER2) overexpression, following adjuvant therapy with paclitaxel liposomes, trastuzumab, and pertuzumab. Heart failure with reduced ejection fraction (HFrEF) occurred after five cycles of anti-HER2 therapy, which improved with chronic heart failure (CHF) treatment. The MCG scan of this patient was significantly abnormal when she developed symptomatic HFrEF, which improved gradually during CHF treatment. Conclusion: The patient's heart failure was most likely caused by HER2-targeted agents, which was reversible and could be improved with the administration of angiotensin receptor neprilysin inhibitor (ARNi) and sodium-glucose cotransporter-2 inhibitor (SGLT2i). In the future, OPM-MCG may act as a safe, accurate, and efficient evaluation tool for cardiotoxicity monitoring to detect early myocardial injury in cancer patients.
