Neuroendocrine Neoplasms of the Breast: The Latest WHO Classification and Review of the Literature

Breast tumors with neuroendocrine (NE) differentiation comprise an uncommon and heterogeneous group of tumors, including invasive breast cancer of no special type (IBC-NST) with NE features, neuroendocrine tumors (NETs), and neuroendocrine carcinoma (NEC). The most recent World Health Organization (WHO) classification in 2019 defined neuroendocrine neoplasms (NENs) of the breast (Br-NENs) as tumors in which >90% of cells show histological evidence of NE differentiation, including NETs (low-grade tumors) and NEC (high-grade). Due to the low prevalence of these tumors and successive changes in their diagnostic criteria over the years, only limited evidence of these tumors exists, derived mainly from case reports and retrospective case series. Breast tumors with NE differentiation are usually treated like the more commonly occurring IBC-NSTs. Immunohistochemistry (IHC) of breast tumors with NE differentiation usually shows a hormone receptor (HR)-positive and human epidermal growth factor type 2 (HER2)-negative profile, so that hormonal therapy with cyclin-dependent kinase (CDK)4/6 inhibitors or other targeted agents would be reasonable treatment options. Herein, we present a review of the literature on breast tumors with NE differentiation as defined in the latest WHO 2019 classification, and discuss the clinical management of these tumors.

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Acute Renal Failure in a Patient with Rivaroxaban-Induced Hypersensitivity Syndrome: A Case Report with a Review of the Literature and of Pharmacovigilance Registries

Case Reports in Nephrology ◽

10.1155/2020/6940183 ◽

2020 ◽

Vol 2020 ◽

pp. 1-6

Author(s):

Gisela Marcelino ◽

Ould Maouloud Hemett ◽

Eric Descombes

Keyword(s):

Renal Failure ◽

Acute Renal Failure ◽

Adverse Events ◽

Case Reports ◽

Vitamin K Antagonists ◽

Clinical Manifestations ◽

Hypersensitivity Syndrome ◽

World Health ◽

Low Grade ◽

Review Of The Literature

Direct oral anticoagulants (DOACs) are among the most commonly prescribed medications, and DOAC-associated kidney dysfunction may be a problem that is underrecognized by clinicians. We report on the case of an 82-year-old patient who, two weeks after the prescription of rivaroxaban for atrial fibrillation, was hospitalized for a drug-induced hypersensitivity syndrome whose main clinical manifestations were low-grade fever with a petechial rash in the legs and acute renal failure (ARF). Within one week after rivaroxaban withdrawal, the patient’s clinical condition improved and the renal function normalized. In a review of the literature, we only found five case reports of rivaroxaban-related ARF: two patients had tubulo-interstitial nephritis (TIN), two had anticoagulant-related nephropathy (ARN), and the last one had IgA nephropathy. As some recent publications suggest that kidney injury due to anticoagulation drugs may be largely underdiagnosed, we also analyzed the data from the VigiAccess database, the World Health Organization pharmacovigilance program that collects drug-related adverse events from 134 national registries worldwide. Among all the rivaroxaban-associated adverse events reported in VigiAccess since 2006, 4,323 (3.5%) were renal side effects, of which 2,351 (54.3%) were due to unspecified ARF, 363 (8.4%) were due to renal hemorrhage (characteristically associated with ARN), and 24 (0.6%) were due to TIN. We also compared these results with those reported in VigiAccess for other DOACs and vitamin K antagonists. This analysis suggests that the frequency of renal adverse events associated with rivaroxaban and other DOACs may be appreciably higher than what one might currently consider based only on the small number of fully published cases.

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Dedifferentiated Chondrosarcoma in the Dog and Cat: A Case Series and Review of the Literature

Journal of the American Animal Hospital Association ◽

10.5326/jaaha-ms-6566 ◽

2018 ◽

Vol 54 (1) ◽

pp. 50-59 ◽

Cited By ~ 3

Author(s):

Arathi Vinayak ◽

Deanna R. Worley ◽

Stephen J. Withrow ◽

Dustin S. Adams ◽

Barbara E. Powers

Keyword(s):

Medical Records ◽

Treatment Options ◽

Case Series ◽

Low Grade ◽

Survival Times ◽

Dedifferentiated Chondrosarcoma ◽

Retrospective Case ◽

Diagnostic Laboratory ◽

Term Survival ◽

Colorado State University

ABSTRACT This retrospective case series describes seven dogs and one cat diagnosed with dedifferentiated chondrosarcoma, an uncommon, aggressive variant of chondrosarcoma. The purpose of the study is to describe clinical, imaging, and histopathological findings of this tumor. Medical records and the diagnostic laboratory database at Colorado State University from 2000 to 2015 were reviewed and complete medical records were available for the eight animals in this report. Similar to what has been reported in people, poor long-term survival and high metastatic rate, particularly to the lungs, was observed in our case series. A bimorphic pattern on imaging (radiographs, computed tomography, and MRI) consisting of mineralized and nonmineralized areas was seen mirroring the high-grade sarcomatous component adjacent to a low-grade chondroid component seen histopathologically. A review of the human literature including suspected etiology, imaging findings, histopathology, and survival times with various treatment options is presented. This article describes the first reported cases of dedifferentiated chondrosarcoma in the veterinary literature. Early accurate recognition could lead to treatment plans tailored to this variant.

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Head and Neck Cancer with Lung Metastases: Treatment Challenges

Clinical Cancer Drugs ◽

10.2174/2212697x06666190701113911 ◽

2019 ◽

Vol 6 (1) ◽

pp. 48-53

Author(s):

Selvamalar Vengathajalam ◽

Norhafiza Mat Lazim

Keyword(s):

Head And Neck Cancer ◽

Head And Neck ◽

Neck Cancer ◽

Lung Metastases ◽

Case Reports ◽

Primary Tumour ◽

Treatment Options ◽

Case Series ◽

Low Grade ◽

First Case

Background:Head and neck cancer has predilection of metastasising to the lung, bones or liver. The site of metastasis usually depends on the primary tumour location, the staging and the regional spread of the tumour. Patients with distant metastasis are predicted to have a poor prognosis with low survival rate. Oligometastasis is the term used for an intermediate biologic state of restricted metastatic capacity with limited number and sites of organ with metastasis. It is also defined by 5 or less than 5 metastatic lesion in a disease with a controlled primary tumour.Case Reports:In this case series, we have reported three cases of head and neck carcinomas that pose treatment dilemmas because of lung metastases. First case is a gentleman with laryngeal carcinoma with multiple small lung metastases where the treatment options of surgery versus chemoradiation was debated. The second case is a gentleman with low grade mucoepidermoid carcinoma of the parotid gland with suspicious lung spread of disease. Lastly is a patient with papillary thyroid carcinoma with florid lung metastases who completed chemoradiation.Conclusion:The presence of lung metastases does not necessarily mean that the prospect of surviving is poor for the patient. It is necessary to determine the best choice of treatment yielding the best quality of life to maximize the survival period for these patients.

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PATH-36. SYNCHRONOUS TTF-1-POSITIVE TUMORS AND PITUITARY ADENOMAS. ARE WE SENDING INSUFFICIENT TUMOR TISSUE FOR PATHOLOGY?

Neuro-Oncology ◽

10.1093/neuonc/noaa215.717 ◽

2020 ◽

Vol 22 (Supplement_2) ◽

pp. ii172-ii172

Author(s):

Franco Rubino ◽

Daniel Eichberg ◽

Ashish shah ◽

Evan Luther ◽

Victor Lu ◽

...

Keyword(s):

Pituitary Adenoma ◽

Pituitary Tumor ◽

Cushing Syndrome ◽

Case Reports ◽

Case Series ◽

Pituitary Tumors ◽

World Health ◽

Low Grade ◽

Posterior Pituitary ◽

Female Ratio

Abstract BACKGROUND Tumors of the posterior pituitary are a distinct group of low-grade neoplasms arising from the sellar region. According to the most recent World Health Organization (WHO) guidelines, these tumors are grouped based on TTF-1 immunostain positivity. The coexistence of a posterior and anterior pituitary tumors is statistically extremely unlikely. OBJECTIVE In this study, we present a case of a 41-year-old woman suffering from Cushing syndrome with the presence of two pituitary masses on MRI. Also, the relevant literature is systematically reviewed. METHODS Two databases (PubMed and Google Scholar) and crossed references were systematically reviewed for TTF-1 pituitary tumors with coexisting pituitary adenoma or increased pituitary serum hormone levels. A literature review was performed according to PRISMA guidelines. Also, one patient from our institution is reported. Data regarding demographic features, type of anterior and posterior pituitary tumor, clinical features of the patients and lab results, MRI findings, and pathology results were extracted. RESULTS Seventeen retrospective case reports and case series were identified and included. Twenty-four patients were analyzed (including the reported case). The mean age was 46 ± 16 years, with a male-to-female ratio of 0.33:1. Pituicytomas and granular cell tumors were the only posterior pituitary tumors reported in 19 (79%) and 5 (21%) cases, respectively. There are only eight cases reported (including our patient) with a confirmed pituitary adenoma and a TTF-1 pituitary tumor (one GCT with GH-secreting adenoma, five pituicytoma with ACTH-secreting adenoma, one with GH-secreting adenoma and one with a null type adenoma). CONCLUSION We presented the eighth reported case of a TTF-1 pituitary tumor coexisting with a pituitary adenoma. We think that improving the amount of the tissue specimen available for pathology evaluation could increase the incidence of these very rare tumors.

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Sunitinib Treatment for Advanced Paraganglioma: Case Report of a Novel SDHD Gene Mutation Variant and Systematic Review of the Literature

Frontiers in Oncology ◽

10.3389/fonc.2021.677983 ◽

2021 ◽

Vol 11 ◽

Author(s):

Franz Sesti ◽

Tiziana Feola ◽

Giulia Puliani ◽

Roberta Centello ◽

Valentina Di Vito ◽

...

Keyword(s):

Systematic Review ◽

Novel Mutation ◽

Case Reports ◽

Therapeutic Option ◽

Case Series ◽

Cochrane Library ◽

Neuroendocrine Neoplasms ◽

Antiangiogenic Agents ◽

Review Of The Literature ◽

Sunitinib Treatment

BackgroundParagangliomas (PGLs) are neuroendocrine neoplasms arising from chromaffin cells of sympathetic or parasympathetic paraganglia. Systemic therapies have been used only in metastatic PGLs. Antiangiogenic agents, such as sunitinib, could be a viable therapeutic choice in the subgroup of patients with SDH-positive PGLs. We describe the case of a man with Familial Paraganglioma Syndrome type 1 (FPGL) related to a novel mutation in SDHD gene treated with sunitinib. Furthermore, we performed a systematic review of the literature aimed to address the following question: is sunitinib treatment effective in patients with advanced/progressive/metastatic PGL?MethodsWe performed a data search using MEDLINE, Cochrane Library, and Scopus between April 2019 and September 2020. We included studies reporting data on clinical or biological characteristics, or clinical outcomes of patients with PGLs treated with sunitinib.ResultsThe search leaded to the selection of 25 publications. Data from case reports and case series showed that disease control rate (DCR = stable disease + partial response + complete response) was achieved in 34.7% of cases under sunitinib treatment. In 39% of patients DCR was followed by progressive disease (PD) or tumor relapse, 26.1% patients showed PD. Data from clinical trials showed that DCR was 83%, and the median progression free survival was 13.4 months.DiscussionData from the present literature review suggested that sunitinib could be a viable therapeutic option in advanced/progressive/metastatic inoperable PGLs. However, further trials on the efficacy of sunitinib in FPGL and sporadic PGL are needed.

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Intraductal papillary neoplasm of bile ducts: report of a case and literature review

International Surgery Journal ◽

10.18203/2349-2902.isj20192997 ◽

2019 ◽

Vol 6 (7) ◽

pp. 2579

Author(s):

Nuray Colapkulu ◽

Gurhan Bas ◽

Fatih Buyuker ◽

Damla Beyazadam ◽

Ibrahim A. Ozemir ◽

...

Keyword(s):

Bile Duct ◽

Bile Ducts ◽

Case Reports ◽

Case Series ◽

Endoscopic Biopsy ◽

World Health ◽

Retrospective Case ◽

Intraductal Papillary Neoplasm ◽

Invasive Component ◽

Papillary Neoplasm

A 67 year old male with right upper quadrant abdominal pain diagnosed with intraductal papillary neoplasm of bile ducts (IPNB) by endoscopic biopsy. The patient was treated surgically and disease free on first year follow-up. Intraductal papillary neoplasm of bile duct (IPNB) is a rare entity with malignant counterparts and recently classified by The World Health Organization. The aim of this study is to present a case of IPNB and review the literature. Pubmed/MEDLINE was searched and articles were extracted. Twenty four case reports and 17 retrospective case series were evaluated. From 41 studies, 824 cases were included. There was slight male predominancy among patients and almost all cases were from eastern countries. Even though the etiology remains unclear, hepatolithiasis was the most common potential etiological association. Most cases were treated with surgical intervention. More than half of the 577 resected specimens had invasive component. Incidence rate of histopathological subtypes were as fallowed: Intestinal (35%), pancreaticobiliary (32%), gastric (19%) and oncocytic (12%). Intraductal papillary neoplasm of bile duct has an increased malignancy rates at postoperative pathological diagnosis, consequently early surgical management is important.

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Pelvis apofysial avulsion fractures: three amateur football player case reports and a review of the literature

TRAUMA ◽

10.22141/1608-1706.2.22.2021.231960 ◽

2021 ◽

Vol 22 (2) ◽

pp. 57-61

Author(s):

Mehmet Ali Sabır ◽

Savaş Yıldırım ◽

Mert Özcan

Keyword(s):

Surgical Treatment ◽

Case Reports ◽

Treatment Options ◽

Case Series ◽

Football Player ◽

Soccer Players ◽

Patient Treatment ◽

Review Of The Literature ◽

Avulsion Fractures ◽

Inappropriate Treatment

Apophysial avulsion fractures of the pelvis are injuries due to sudden and strong muscle contractions that affect athletes during adolescence. It has become more common today due to the increase in sportive activities. Inappropriate treatment methods cause painful joint movements and therefore the return of patients to sportive activity is delayed. Case series of three amateur soccer players were presented in this report. Unsuccessfull conservative treatment two of the patients were treated surgically after that caused impingement symptoms. İmmediate surgical treatment was performed in one patient. Treatment options and complications were explained under the light of current literature concepts.

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Temporoparietal Gliosarcoma : A Case Report with Literature Review

Indonesian Journal of Neurosurgery ◽

10.15562/ijn.v1i1.4 ◽

2018 ◽

Vol 1 (1) ◽

Author(s):

Faried Ahmad ◽

Bethy S Hernowo ◽

Achmad Adam ◽

Muhammad Z Arifin

Keyword(s):

Case Reports ◽

Malignant Gliomas ◽

Case Series ◽

World Health ◽

Imaging Studies ◽

Retrospective Case ◽

Tumor Mass ◽

Histopathology Finding ◽

Aggressive Tumor ◽

Health Organization

Gliosarcoma (GSM) is a primary tumor of the central nervous systemcomposed of both malignant glial and sarcomatous elements. GSM isclassified as grade IV according to World Health Organization (WHO)and regarded as aggressive tumor and often requires both surgeryand radiotherapy. The incidence of GSM is between 1.8%-2.8% ofall malignant gliomas and thus represents an exceptionally rareneoplasm. Consequently, our knowledge about this entity is limited tosmall retrospective case series and case reports. Here, we describe acase of a 46-year-old male with progressive right extremity weakness,accompanied with aphasia. Imaging studies showed a tumor mass inthe left temporoparietal region. Surgery was performed and gross totalremoval was achieved. Histopathology finding established a diagnosisof GSM. The extremity weakness was improved postoperatively withina week.

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Impact of Pathological Stratification on the Clinical Outcomes of Advanced Well-Differentiated/Dedifferentiated Liposarcoma Treated with Trabectedin

Cancers ◽

10.3390/cancers13061453 ◽

2021 ◽

Vol 13 (6) ◽

pp. 1453

Author(s):

Chiara Fabbroni ◽

Giovanni Fucà ◽

Francesca Ligorio ◽

Elena Fumagalli ◽

Marta Barisella ◽

...

Keyword(s):

Clinical Outcomes ◽

Proportional Hazards ◽

Case Series ◽

Progression Free Survival ◽

Cox Proportional Hazards ◽

Low Grade ◽

High Grade ◽

Retrospective Case ◽

Well Differentiated ◽

The Impact

Background. We previously showed that grading can prognosticate the outcome of retroperitoneal liposarcoma (LPS). In the present study, we aimed to explore the impact of pathological stratification using grading on the clinical outcomes of patients with advanced well-differentiated LPS (WDLPS) and dedifferentiated LPS (DDLPS) treated with trabectedin. Patients: We included patients with advanced WDLPS and DDLPS treated with trabectedin at the Fondazione IRCCS Istituto Nazionale dei Tumori between April 2003 and November 2019. Tumors were categorized in WDLPS, low-grade DDLPS, and high-grade DDLPS according to the 2020 WHO classification. Patients were divided in two cohorts: Low-grade (WDLPS/low-grade DDLPS) and high-grade (high-grade DDLPS). Results: A total of 49 patients were included: 17 (35%) in the low-grade cohort and 32 (65%) in the high-grade cohort. Response rate was 47% in the low-grade cohort versus 9.4% in the high-grade cohort (logistic regression p = 0.006). Median progression-free survival (PFS) was 13.7 months in the low-grade cohort and 3.2 months in the high-grade cohort. Grading was confirmed as an independent predictor of PFS in the Cox proportional-hazards regression multivariable model (adjusted hazard ratio low-grade vs. high-grade: 0.45, 95% confidence interval: 0.22–0.94; adjusted p = 0.035). Conclusions: In this retrospective case series, sensitivity to trabectedin was higher in WDLPS/low-grade DDLPS than in high-grade DDLPS. If confirmed in larger series, grading could represent an effective tool to personalize the treatment with trabectedin in patients with advanced LPS.

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