Adult T-cell leukemia/lymphoma (ATLL) is an aggressive lymphoma with a poor prognosis. The human T-lymphotropic virus 1 (HTLV-1) is associated with immunodeficiency and increased extranodal involvement in patients with diffuse large B-cell lymphoma (DLBCL). We report on a 47-year-old woman with spastic paraparesis and hepatitis B who was diagnosed with the acute form of ATLL. The clinical picture reveals peripheral generalized lymphadenopathy and splenomegaly. Findings on a hematologic exam indicated leukocytosis with lymphocytosis. A bone marrow biopsy/aspiration confirmed 50% T-cell lymphoid infiltration. Biochemistry results revealed hypercalcemia and a high lactate dehydrogenase value. Results of a CT scan indicated abdominal and thoracic adenopathy as well as moderate splenomegaly. A supraclavicular lymph node biopsy established a DLBCL diagnosis. The final diagnosis was composite lymphoma, DLBCL, and ATLL. The CHOP (cyclophosphamide, doxorubicin hydrochloride, vincristine sulfate [Oncovin], and prednisone) regimen was chosen due to the patient's ECOG performance status. Multiple infectious complications were diagnosed during chemotherapy-induced secondary aplasia. A complete remission, confirmed via PET-CT imaging, was obtained. After 1 month, a skin tumor on the upper right thigh was discovered and biopsied, and the histopathological exam and immunochemistry findings indicated Epstein-Barr virus-DLBCL lymphoma. The association of 2 aggressive lymphomas in a single HTLV-1 carrier is a rare report, and the evolution was severe, complicated by opportunistic infections, and unfavorable.
BACKGROUND:Breast cancer is the most prevalent malignancy among women and frequently causes significant psychological distress, such as anxiety and depression. The perception and impact of social support in addressing these mental health challenges differ depending on cultural and societal factors, highlighting its crucial role. AIM:This study aimed to evaluate the association between anxiety and depression in Palestinian women with breast cancer and perceived social support (PSS). METHODS:A descriptive, cross-sectional design was employed. The study included 257 patients with breast cancer. Anxiety and depression were evaluated using the Hospital Anxiety and Depression Scale. PSS was measured using the Medical Outcomes Study Social Support Survey. RESULTS:Most participants (95%) were married. The mean age was 51 ± 9.8 years. The total PSS was relatively mild to moderate (M = 69.7 ± 9.5). The scores for anxiety and depression were in the borderline range(M = 7.8 ± 3.3 and M = 8.3 ± 3.6, respectively). All subclasses of PSS were negatively correlated with anxiety and depression ( P < .05). CONCLUSION:Every individual has a unique perception of social support. Depression and anxiety affect a sizable percentage of patients with breast cancer. Higher levels of social support may also assist in reducing depression and anxiety, as seen by the strong negative association found between these psychological states and PSS.
BACKGROUND:Patients with metastatic renal cell carcinoma (mRCC) treated with immune checkpoint inhibitors (ICIs), alone or in combination with tyrosine kinase inhibitors (TKIs), often experience significant treatment-related adverse events, including fatigue, that can impair health-related quality of life (HRQOL). Structured exercise interventions may mitigate these symptoms, but data in mRCC are limited. OBJECTIVE:To evaluate the feasibility and impact of a 12-week supervised remote exercise program on HRQOL, fatigue, and symptom burden in patients with mRCC receiving ICIs or ICI-TKI combinations. METHODS:Nineteen patients with mRCC (median age 67 years; 57.9% male) participated in a 12-week home-based exercise program, supervised via telehealth. The program included aerobic, resistance, and mobility exercises delivered through weekly virtual consultations and supported by the Vedius platform. Outcomes were assessed at baseline and post intervention using the Functional Assessment of Cancer Therapy-Immune Checkpoint Modulator (FACT-ICM), Brief Fatigue Inventory (BFI), and Edmonton Symptom Assessment System (ESAS). RESULTS:Participants demonstrated significant improvements in overall HRQOL (FACT-General mean increase, 9.8 points; P = .001; Cohen d = 0.8), treatment-related toxicity (ICM mean increase, 10.1 points; P = .017), and fatigue (BFI mean decrease, 21.1 points; P = .018; ESAS fatigue mean decrease, 5.0 points; P = .001; Cohen d = -1.5). Symptom burden (ESAS mean decrease, 12.3; P = .001) and key patient-reported outcomes, including anxiety, depression, appetite loss, and sleep disturbances, also improved ( P ≤ .02). CONCLUSIONS:A 12-week supervised remote exercise program was feasible and associated with meaningful improvements in HRQOL, fatigue, and symptom burden among patients with mRCC undergoing ICI-based therapies. These findings support the integration of structured exercise into supportive care for mRCC, highlighting the potential of remote interventions to enhance physical and emotional well-being. Future studies should confirm these results in larger randomized trials and identify the most effective program components.
Objective: Given disparities in incidence and outcomes among racial and ethnic groups, and differences in patient characteristics among the 3 main types of gynecologic cancer, we examined whether clinical trial availability at a large, high-enrolling National Cancer Institute–designated Comprehensive Cancer Center reflects the clinical volume of each cancer in the catchment area. We also assessed whether the patients who consented to the trials reflected the racial and ethnic distribution of each cancer type. Methods: Patients who consented to ovarian, uterine, and cervical cancer clinical trials at the UCLA Jonsson Comprehensive Cancer Center in Los Angeles, California, from 2013 through 2018 were included. Clinical trial and patient-level data were collected. Los Angeles County cancer incidence data were used to represent disease burden in the catchment area. χ-Square and Fisher exact tests were used to compare proportions. Results: Twenty-four gynecologic oncology clinical trials were identified: 16 (67%) ovarian, 5 (21%) uterine, and 3 (12%) cervical cancer trials. Compared with corresponding county incidence rates, respectively, the proportion of patients with ovarian (82% vs 25%), uterine (9% vs 59%), or cervical (9% vs 6%) cancer who consented for clinical trials differed significantly ( P < .001). The racial/ethnic distribution of patients also differed for ovarian ( P < .001) and cervical cancer trials ( P = .005). Patients who were Black or Asian were underrepresented in ovarian and cervical cancer trials; Hispanic patients were underrepresented in ovarian trials. Conclusions: The distribution of clinical trials and patients who consented did not reflect the incidence or racial and ethnic makeup of gynecologic cancers in the catchment area. Greater efforts are needed to align trial availability and enrollment with disease burden and population diversity.
Purpose: To present a rare case of proximal-type epithelioid sarcoma (PES) of the vulva and highlight the importance of a multidisciplinary approach in its diagnosis and treatment, especially in the context of SMARCB1 loss. Methods: A 41-year-old woman presented with a painless mass in the right labia majora. An MRI, PET/CT, histopathology, and immunohistochemistry confirmed the diagnosis of PES with loss of SMARCB1 expression. The patient underwent wide local excision followed by re-excision and inguinal lymphadenectomy. Adjuvant radiotherapy was initiated but discontinued at 46 Gy due to grade 2 skin reactions and wound dehiscence. Results: Posttreatment PET/CT imaging posed challenges in distinguishing between recurrence and radiation-induced changes. Despite these challenges, the patient remained disease free during the 2-year follow-up period. This case underscores the diagnostic and therapeutic complexities involved in treating PES, particularly in sensitive anatomical regions such as the vulva. The loss of SMARCB1 served as a key molecular marker guiding diagnosis and therapeutic decisions. Conclusion: The case underscores the importance of a comprehensive, individualized treatment approach, including surgery, radiotherapy, and advanced imaging, for managing rare malignancies such as vulvar PES.
Interim fluorodeoxyglucose (FDG)-PET is currently the most used predictor of early response to treatment in advanced-stage Hodgkin lymphoma. Patients with a negative PET after 2 cycles of chemotherapy (PET2) have a better treatment outcome than their counterparts. The objective of this review was to assess how PET-adapted treatment approaches have enhanced the management of advanced-stage Hodgkin lymphoma by adapting treatment according to initial response. PubMed, Web of Science, ScienceDirect, Google Scholar, Scopus, and the Cochrane Library were systematically searched using randomized controlled trials, phase 2/3 clinical trials, and systematic reviews between 2000 and 2024. Keywords used were "Hodgkin lymphoma," "PET-adapted treatment," "ABVD," "BEACOPP," "interim PET," and "treatment escalation/de-escalation." PET-adapted treatment strategies decrease PET2-negative patient treatment, decreasing adverse effects with no reduction in effectiveness, as evidenced by the RATHL, AHL2011, and HD18 trials. In PET2-positive patients, trials such as SWOG S0816 and HD0607 prove that the early intensification of treatment improves survival. Novel treatments, such as brentuximab vedotin and nivolumab, are promising options.
Adult granulosa cell tumor (GCT) of the ovary is a rare sex cord-stromal neoplasm characterized by potential for late recurrence. Hepatic metastases from GCT are exceedingly uncommon. We report a case of late hepatic relapse occurring 15 years post primary treatment. A 66-year-old woman with obesity presented with right upper quadrant pain of 1-month duration. She had a history of stage T1aN0M0 right ovarian GCT treated 15 years prior with total abdominal hysterectomy, bilateral oophorectomy, omentectomy, and adjuvant chemotherapy, with no follow-up. Imaging revealed extensive perihepatic and intrahepatic lesions and a midabdominal mass. Laparotomy confirmed an abdominal mass greater than 15 cm and multiple hepatic lesions. Excisional histopathology demonstrated metastatic GCT of the liver and peritoneum. This case emphasizes the need for lifelong surveillance in patients with GCT due to its latent recurrence potential even beyond a decade.
A 76-year-old man presented with a subtle, non-mass-like right insular and temporal opercular T2 FLAIR hyperintensity that remained stable for over 2 years before showing interval progression. Resection revealed mildly hypercellular atypical glial cells with a Ki-67 index of approximately 1% and no necrosis or microvascular proliferation. Immunohistochemistry was negative for IDH1 R132H. Next-generation sequencing identified a TERT promoter mutation, EGFR amplification, and CDKN2A deletion. Methylation profiling confirmed glioblastoma, IDH wild-type, World Health Organization grade 4. Despite lacking classic histologic features, the integrated molecular findings established the diagnosis. The patient underwent near-total resection, followed by hypofractionated radiotherapy with concurrent temozolomide, maintenance temozolomide, and tumor treating fields therapy. This case highlights the essential role of molecular diagnostics in accurately classifying diffuse gliomas with atypical histology.
Background: Docetaxel and capecitabine combination have not previously been studied in advanced head and neck squamous cell carcinoma (HNSCC). This study aimed to evaluate the combination's safety and efficacy in this population. Materials and methods: In this single-arm phase 2 trial, patients with advanced HNSCC received docetaxel 75 mg/m2 intravenously on day 1 in combination with oral capecitabine 800 to 1000 mg/m(2) twice daily from days 1 to 14 of a 3-week cycle, until either progression or toxicity. Results: A total of 14 patients were enrolled in the trial. All participants were men, with a median age of 66 years (range, 47-80). Twelve patients (86%) had received prior chemotherapy. Among the 9 evaluable patients, 1 patient achieved a partial response, 6 had stable disease, and 2 had progression. The median progression-free survival was 4.9 months (95% CI, 1.1-8.2), and the median overall survival was 8.7 months (95% CI, 4.8-17.0). The regimen had an acceptable safety profile. The trial was terminated early due to a change in the standard of care with the introduction of immunotherapy. Conclusions: Despite the trial's early termination, the combination demonstrated a decent disease stability rate with acceptable toxicity. This regimen can be considered for patients with good functional status.
Obesity and weight gain are associated with adverse outcomes following breast cancer diagnosis; some breast cancer treatments contribute to postdiagnosis weight gain. We evaluated patients with breast cancer who were prescribed a glucagon-like peptide-1 receptor agonist (GLP-1 RA), with follow-up weight data available. Weights were categorized by time from GLP-1 RA initiation; a linear mixed effects model with a random intercept for baseline weight was used to assess mean weight change at each time point. Among 75 patients, the median age was 52 years (range, 27-74), 62 (86%) were postmenopausal, and 59 (79%) had diabetes. Additionally, 68 (91%) patients had stage 0 to III breast cancer, and 62 (84%) had estrogen receptor-positive disease. The median body mass index (BMI) at baseline was 34 (range, 23-50). The mean weight change was-2.9 kg (95% CI, -4.1 to-1.7) at 6 months and-4.2 kg (95% CI, -5.5 to-2.9) at 12 months; mean weight change at 12 months was-5% (95% CI, -6%to-3%). In univariable and multivariable analyses, age, baseline BMI, diabetes, stage, histology, receptor status, menopausal status, and concurrent endocrine therapy use were not significantly associated with 5% or greater weight loss at 12 months. These results support the development of clinical trials to optimize the use and dosing of GLP-1 RAs for weight loss in patients with breast cancer.
The COVID-19 pandemic has exposed significant vulnerabilities among patients who are immunocompromised, who remain at increased risk for severe disease despite widespread vaccination in the general population. This commentary reviews insights from Dorry L. Segev's, MD, PhD, keynote lecture at Med News Week, highlighting reduced vaccine efficacy, prolonged viral shedding, and increased severity of COVID-19 in this population. Emerging strategies such as monoclonal antibody prophylaxis, oral antivirals, personalized vaccine approaches, and T cell-based therapies show promise in mitigating these risks. Additionally, the commentary discusses the implications of hybrid immunity and the potential for within-host viral evolution to generate resistant variants, underscoring the need for targeted genomic surveillance. Ethical considerations are raised regarding the use of advanced oncologic treatments with marginal survival benefits but substantial toxicity in the context of COVID-19 vulnerability. To effectively protect immunocompromised patients, tailored public health measures, dedicated vaccination programs, and integrative lifestyle interventions are required. Synergistic efforts among clinicians, researchers, and policy makers are essential to ensure equitable access to preventive and therapeutic strategies, strengthening health care resilience for vulnerable populations during the ongoing pandemic and beyond.
Leptomeningeal disease (LMD) is the spread of cancer cells to the arachnoid mater, pia mater, and cerebrospinal fluid. It occurs in 5% to 10% of solid organ cancers, with higher rates in breast, lung, and melanoma cancers. The prognosis for patients with LMD remains poor, with a median survival of 1.5 months without treatment and 2 to 3 months with treatment, despite advances in cancer treatment. This retrospective study included 64 patients with LMD with primary cancers represented in the diagnosis-specific Graded Prognostic Assessment (DS-GPA) at a single institution over 5 years. Patient characteristics, treatment, and overall survival (OS) data were collected. Statistical analyses included descriptive statistics, log-rank tests, and Cox proportional hazards regression models. The median OS for the 64 patients with LMD was 2.6 months, with no statistically significant differences among cancer types. Though not statistically significant, those with higher DS-GPA scores trended toward longer survival in breast and lung cancer cohorts. Patients with LMD on imaging confined to 1 location (cerebrum, cerebellum, spine, or cranial nerves) and receiving systemic chemotherapy alone also had longer survival. The DS-GPA tool is promising for LMD prognostication and may be strengthened by incorporating imaging and chemotherapy characteristics. Larger, multicenter studies are needed to validate its prognostic utility. Keywords: Leptomeningeal disease, diagnosis-specific graded prognostic assessment, prognosis, overall survival, breast cancer, lung cancer.
Anaplastic large cell lymphoma (ALCL) is a rapidly growing and aggressive hematological malignancy. We present the case of a 12-year-old adolescent boy with a 2-week history of left iliac fossa and presacral pain radiating to the lower limbs associated with emesis and constipation. Subsequently, the patient developed poorly controlled hypertension and progressive lower limb weakness. Imaging revealed an intradural extramedullary mass at the L1 level, and pathology reported large, atypical cells consistent with ALK -positive ALCL. This case highlights the rarity of isolated intradural extramedullary manifestations in the pediatric population. Keywords : Anaplastic large-cell lymphoma; human central nervous system neoplasms; pediatric oncology; intradural neoplasms; treatment outcome; ALK protein, human.
Under normal physiological circumstances, an equilibrium exists between prooxidants and antioxidants in the body. The body generates free radicals as part of its natural cellular metabolism. However, when there is an unevenness or modification in the levels of antioxidants, it gives rise to a state known as oxidative stress. This phenomenon is implicated in numerous pathological conditions. It can potentially harm cells by causing minor injuries to cell membranes, deactivating proteins, damaging DNA, and triggering tissue damage through cell-signaling molecules. Human saliva is a diagnostic fluid that is rich in antioxidant compounds and plays a primary role in the protective mechanism. These antioxidants neutralize the free radicals, including reactive oxygen species and reactive nitrogen species, that are released due to oxidative stress and prevent cell breakdown, tissue damage, and DNA mutations. Whole human saliva may contain numerous antioxidants that are measurable tools to monitor the oral cavity's oxidative processes and help guide the development of new drugs or treatment plans. This article provides extensive information on salivary antioxidants and their role in common oral lesions like inflammatory, premalignant, malignant, and autoimmune diseases.
Immune checkpoint inhibitors (ICIs) are increasingly used in the treatment of advanced malignancies, but they can cause a wide range of adverse effects, including inflammatory arthritis. Severe ICI-induced inflammatory arthritis (ICI-IA) is rare, and its distinguishing clinical features are not defined. We present a patient with metastatic urothelial carcinoma who developed severe, polyarticular inflammatory arthritis while being treated with an ICI. Arthrocentesis of native and prosthetic joints revealed a significantly elevated white blood cell (WBC) count with a neutrophil predominance. Antibiotics were discontinued when the extensive infectious workup remained negative, and the patient was diagnosed with ICI-IA. This presentation of ICI-IA had overlapping features with septic arthritis, resulting in high diagnostic uncertainty. We comprehensively reviewed all published literature on the clinical features of severe ICI-IA. In the literature, synovial fluid findings revealed variable WBC counts but consistently have a neutrophil predominance. Although severe cases are rare, 9 previously reported cases shared similarities, including polyarticular presentation, elevated inflammatory markers, and absence of other rheumatic disease. Severe ICI-IA appears to have significant clinical overlap with culture-negative septic arthritis. This case report and literature review emphasize that ICI-IA should not be ruled out based on the presence of synovial fluid with elevated WBC with a neutrophil predominance. Early steroid use should be considered.
INTRODUCTION:There are limited data available regarding patient outcomes in those who would have been ineligible to receive therapy based on the original clinical trial eligibility criteria. We decided to conduct a retrospective study to evaluate outcomes based on clinical trial eligibility in patients with metastatic non-small cell lung cancer (NSCLC). METHODS:A retrospective chart review of all patients with metastatic NSCLC who received first-line systemic therapy at a single academic institution was performed. Each patient's chart was reviewed to determine if they would have qualified for the phase 3 clinical trial that led to the approval of the specific treatment regimen which they received. Data were analyzed to determine if there was a difference in survival time between those who would have been eligible compared with those who were ineligible for the clinical trial of the treatment regimen administered. RESULTS:There were 170 patients with a diagnosis of metastatic NSCLC who received first-line systemic therapy. Of these, 109 received combined chemotherapy, 25 received immunotherapy, and 36 received targeted therapy. There is a statistically significant difference in the restricted mean survival time between the eligible and ineligible groups in those who received combined chemotherapy (19.9 months vs 13.2 months; P = .03), but not in either the immunotherapy group (22.4 months vs 12.9 months; P = .06) or the targeted therapy group (57.7 months vs 39.0 months; P = .14). CONCLUSION:These data support less restrictive clinical trial eligibility criteria for those with metastatic NSCLC. This is especially true regarding both targeted therapy and immunotherapy treatment regimens.
Gastric cancer remains a major global health concern with high incidence and mortality rates, particularly in East Asia. Patients often have poor outcomes due to limited treatment efficacy. Zolbetuximab, a monoclonal antibody targeting claudin 18.2 (CLDN18.2)-overexpressed in 50% to 80% of gastric cancers-demonstrates promise by initiating antibody-dependent cellular cytotoxicity and complement-dependent cytotoxicity in CLDN18.2-positive cells. In clinical trials, zolbetuximab with chemotherapy improved progression-free survival (PFS) and overall survival (OS). The FAST trial showed a median OS increase from 8.4 months to 13.2 months (HR, 0.72; P < .01). The SPOTLIGHT trial found PFS extended to 11.0 months vs. 8.9 months (HR, 0.73; P = .0024) with OS reaching 18.2 months in the zolbetuximab arm. The GLOW trial also confirmed efficacy, with median OS improving from 12.16 months to 14.39 months (HR, 0.771; P = .0118). Zolbetuximab's targeted action, combined with manageable adverse effects, positions it as a promising therapy for advanced gastric cancer.
We present a 65-year-old man with multiple myeloma who developed a rare complication of pleural effusion. Initial laboratory results showed elevated creatinine, calcium, and protein electrophoresis with an M spike. A bone marrow biopsy confirmed 80% plasma cells. Despite the rarity of pleural effusion in patients with multiple myeloma, our patient demonstrated significant improvement with targeted therapy and palliative care. This case highlights the importance of early recognition and management of pleural effusion in patients with multiple myeloma and underscores the need for further research into optimal management strategies and underlying mechanisms.
The Case A 47-year-old woman with a history of drug-resistant epilepsy during childhood presented to the emergency department with sudden dyspnea and chest pain. Upon admission, her oxygen saturation was 88%. A chest CT scan revealed pulmonary cystic lesions consistent with lymphangioleiomyomatosis and a right spontaneous pneumothorax, which resolved with the placement of a chest tube. Physical examination revealed a hypopigmented macule on the skin of the lumbar region, facial angiofibromas, and periungual fibromas. An abdominal MRI documented multiple bilateral renal tumors that were hypointense on T2-weighted imaging and showed a black boundary artifact, suggestive of fat-poor angiomyolipomas (AMLs). Subsequent percutaneous biopsy of the largest renal tumor confirmed the diagnosis of angiomyolipoma (positive for HMB-45 on immunohistochemistry). The brain MRI revealed subependymal nodules. The pulmonary function tests showed a mild obstructive pattern. Germline genetic testing confirmed the suspected diagnosis, and the patient started oral systemic treatment with everolimus (Afinitor) 10 mg once daily, along with dexamethasone rinses for prophylaxis.
