Co-existent breast malignancy and contralateral primary axillary tuberculosis

Breast tuberculosis is an extremely rare entity representing less than 0.1% of all breast disease in developed countries1. Tuberculous infections within the United Kingdom have seen a steady decline with the highest rates present within North West London where infection rates reach 24.8 per 1000002. The presentation can mimic malignancy and lymphatic involvement of the breast both clinically and mammographically, with nodules within the upper outer quadrant, making accurate diagnosis challenging.3 Approximately 30% of breast TB cases present with axillary lymphadenopathy and a recent case series review of approximately 44 cases in London found that the most common presenting feature was a solitary breast lump in 87% of cases.4 We present a case of a patient presenting with primary malignancy and contralateral nodal disease highly suspicious for breast malignancy. Subsequent investigation led to the identification of synchronous localized cancer and tuberculous lymphadenitis. Synchronous presentation is uncommon and recognition and differentiation is vital as axillary lymph node metastasis is the most important factor in the staging of breast carcinoma and determining the subsequent oncological and surgical management.

Identification of an m6A RNA Methylation Regulator Risk Score Model for Prediction of Clinical Prognosis in Astrocytoma

Astrocytoma (AS) is the most ubiquitous primary malignancy of the central nervous system (CNS). The vital involvement of the N6-methyladenosine (m6A) RNA modification in the growth of multiple human tumors is known. This study entailed probing m6A regulators with AS prognosis to construct a risk prediction model (RS) for potential clinical use. A total of 579 AS patients’ (of the Chinese Glioma Genome Atlas,CGGA) data and the expression of 12 published m6A-related genes were included in this study. Cox and selection operator (LASSO) regression analyses for independent prognostic factors and multifactor Cox analysis established an R.S. model to predict the AS patient prognosis. This was subject to verification employing 331 samples from the TCGA data set followed by gene ontology and pathway enrichment study with gene set enrichment analysis (GSEA). The R.S. constructed with three m6A genes inclusive of WTAP, RBM15, and YTHDF2 emerged as independent prognostic factors in AS patients with vital involvement in the advancement and development of the malignancy. In a nutshell, this work reported an m6A-related gene risk model to predict the prognosis of AS patients to pave the way for discerning diagnostic and prognostic biomarkers. Further corroboration employing relevant wet-lab assays of this model is warranted.

Coronary intervention for severe stenosis in the ostial right coronary artery with cardiac angiosarcoma: a case report

Background Although rare, angiosarcoma is the most common type of cardiac primary malignancy. This disease can cause life-threatening complications and the prognosis remains poor. There is no standard approach to care, and clinical judgement is exercised on a case-by-case basis. Tumour progression causes serious complications, such as heart failure and vascular disruption. Case summary A 64-year-old Japanese woman presenting with a right atrial tumour was referred to our department. Tumour biopsy revealed that the patient suffered from angiosarcoma. We performed a lumpectomy to excise the tumour, but due to tissue adhesions in and around the right atrium, the malignancy could not be completely removed. After 3 years of chemotherapy, the patient was admitted to our hospital with increased chest pain. Emergency coronary angiogram revealed severe stenosis of the ostial right coronary artery. Intravascular ultrasound (IVUS) and computed tomography suggested coronary compression due to cardiac angiosarcoma. In this study, we report a unique case of advanced cardiac angiosarcoma, presenting as unstable angina, which was successfully treated with percutaneous coronary intervention using stent implantation. Discussion Due to the rarity of cardiac primary angiosarcoma, many symptoms are misdiagnosed until mechanical complications arise, such as coronary compression. The clinical course and various imaging modalities are useful for differentiating angiosarcomas from coronary stenosis.

Identification of a Potential Autophagy-Associated Therapeutic Target in Osteosarcoma using Bioinformatic Analyses

Background: Osteosarcoma, primarily resulting from mesenchymal cell differentiation, is the most common primary malignancy of the bone in children and adolescents. Metastases to other sites, such as the lung, often occur in the early stages and progress rapidly. Autophagy functions as a tumor-suppressing mechanism in the early stages of oncogenesis, however, in later stages, autophagy may promote tumor growth, spread, and increase treatment resistance. Methods: In the present study, we aimed to screen new key autophagy-related biomarkers that may serve as therapeutic targets for osteosarcoma. The expression profile of the GSE42352 dataset, including 103 OS cell lines and 15 MSC lines from Gene Expression Omnibus (GEO), was analyzed to identify the differentially expressed genes. Results: WGCNA was used to construct the gene co-expression network in osteosarcoma, identify co-expression modules for protein interactions (PPI), and screen the key genes. A total of 757 differentially expressed genes were identified by WGCNA analysis including one key autophagy-related module. Conclusions: Further, we performed the PPI analysis for module genes and identified a key gene. We also theoretically and functionally validated its expression using the validation dataset GSE14359, and in vitro experiments, respectively.

Presumed Melanoma of Unknown Primary Origin Metastatic to the Choroid Mimics Primary Uveal Melanoma

We describe the case of a 69-year-old woman who presented with a decline in vision in the left eye and was found to have a choroidal lesion with clinical and echographic features concerning for primary uveal melanoma. Systemic imaging identified numerous metastases to the liver, kidneys, paratracheal lymph nodes, lung, and brain. The hepatic lesion was biopsied, and genetic analysis identified a Val600Glu (c.1799T&#x3e;A) <i>BRAF</i> mutation, consistent with a cutaneous primary malignancy, although no primary tumor was identified. This case highlights that metastasis to the choroid is a rare presentation of nonuveal melanoma that can mimic primary uveal melanoma. Genetic analysis of tumor tissue can identify the origin of the melanoma and guide treatment options. Systemic imaging should be performed prior to intervention for choroidal neoplasms.

Multiple Primary Malignancies in Patients with Gynecologic Cancer

Objective: To investigate the prevalence and oncologic outcomes of patients with multiple primary malignant tumors (MPMT) with gynecologic cancer. Methods: This retrospective study included 1929 patients diagnosed with gynecologic cancer at a tertiary medical center between August 2005 and April 2021. The clinical data included cancer location, age at primary malignancy diagnosis, interval between primary and secondary cancer, stage of cancer, family history of cancer, genetic testing, dates of last follow-up, recurrence, and death. Results: The prevalence of MPMT with gynecologic cancer in patients was 8.6% and the mean diagnostic period between primary and secondary cancer was 60 months. Furthermore, 20 of the 165 patients with MPMT had multiple primary gynecologic cancers (MPGC), whereas 145 had gynecologic cancer coexisting with non-gynecologic cancer (GNC). Endometrial-ovarian cancer (60%) was the most common coexisting cancer in the MPGC group, whereas the most common non-gynecologic cancer in the GNC group was breast cancer (34.5%). There were 48 patients with synchronous cancer and 117 patients with metachronous cancer. The incidence of synchronous cancer was higher in the MPGC group than in the GNC group (p = 0.037). Significantly more patients had early-stage ovarian cancer in the MPGC group than in the GNC group (p = 0.031). The overall recurrence and mortality rates were 15.8% and 8.5%, respectively, in patients with MPMT. Conclusion: Synchronous cancer incidence was significantly higher in the MPGC than in the GNC group. Early-stage ovarian cancer was more highly diagnosed in patients with MPGC than in those with GNC. A systematic examination after primary cancer diagnosis could facilitate the early diagnosis of secondary primary malignancy, thereby improving patient prognosis.

Nhiều ung thư nguyên phát trên một bệnh nhân

TÓM TẮT Đặt vấn đề: Bệnh cảnh một bệnh nhân mắc nhiều ung thư nguyên phát đã được coi là hiếm gặp, tuy nhiên trong thời gian gần đây cho thấy tần suất mắc bệnh nhiều ung thư nguyên phát (MPMN) trên một bệnh nhân ngày có xu hướng gia tăng. Qua 17 trường hợp được thông báo nhằm mục đích rút kinh nghiệm chẩn đoán để có hướng xử lý kịp thời và tốt hơn trong điều trị và tiên lượng; tạo điều kiện triển khai các nghiên cứu có giá trị hơn trong tương lai Báo cáo các trường hợp: Trong 17 trường hợp: 10 nữ và 7 nam: 4/17 (23,5%) MPMN cùng lúc, 13/17 (76,5%) MPMN phát triển sau đó. Hầu hết bệnh nhân trên 60 tuổi,các ung thư nguyên phát thứ 1 thường thấy ở các vị trí đường tiêu hóa: GIST 4/17 (23,5%) đại trực tràng 2/17 (11,8%), vú 6/17 (35,3%), phổi 2/117 (11,8 %) và ung thư thứ 2 và thứ 3 thường thấy ở đường tiêu hóa 6/17 (35,3 %), phụ khoa 5/17 (29,4%) vú 2/17 (11,8%) và phổi 3/17 (17,6%), 15/17 (88,2%) trường hợp mắc ung thư ở 2 vị trí và 2/17 (11,8 %) trường hơp mắc bệnh ở 3 vị trí. Kết luận: Bệnh cảnh mắc nhiều ung thư trên một bệnh nhân không còn là hiếm gặp. Việc chẩn đoán bệnh cần phải được lưu ý trong thời gian theo dõi bệnh. ABSTRACT A CASE SERIES OF MULTIPLE PRIMARY MALIGNANT NEOPLASMS Background: The development of improved diagnostic techniques, increased incidence of long term survival and life expectancy of cancer patients lead to the higher frequency of multiple primary malignant neoplasms (MPMN). This article aims to report series of cases our observed trend of increasing, in prevalence of both synchronously and metachronously second and third primary malignancy. Among the patients have been diagnosed with a cancer and reviewed in the relevant literature. Case series: Among 17 cases of MPMN that have been reported, 4/17 were synchronous (23.5%) and 13/17 were metachronous (76.5%), out of 17 patients, 10 were femals and 7 were males. The majority of the cases were over 60 years of age. In this report, the most common types of cancer were GIST (Stomach, Small intestine): 4/17 (23.5%); Breast: 6/17 (35.3%), Adenocarcinome of lung and colorectal: 2/17 (11.8%) as the first primary and Adenocarcinoma of gastrointestinal tract: 6/17 (35.3%), lung: 2/17 (11.8%), gynecologic tumors: 5/17 (29.4%), Breast: 2/17 (11.8%), lung: 3/17 (17,6%) as the second or the third primary cancer.Among 17 such patients, 15 and 2 primary malignant lessions occured at 2 sites and 3 sites respectively. Conclusion: The incidence of MPMN has not been rare at all. The diagnosis of MPMN should not be overlooked during follow - up. The doctor - patient relationship remains a critical factor in management. The clinicians should be aware of cases that cancer patients have metastasis in unusual sites and inconsistent clinical progression. Keywords: Multiple malignant neoplasms, primary.

Case Report: Pleuropulmonary Blastoma in a 2.5-Year-Old Boy: 18F-FDG PET/CT Findings

Pleuropulmonary blastoma (PPB) is a rare invasive primary malignancy in the thoracic cavity that occurs mainly in infants and children. It is often misdiagnosed and not treated correctly and promptly due to the lack of specificity of clinical symptoms and conventional imaging presentations. We report a 2.5-year-old boy who underwent X-ray chest radiography, chest CT, and 18F-FDG PET/CT. PET/CT images demonstrated a sizeable cystic-solid mass with heterogeneous increased glucose metabolism in the left thoracic cavity. The diagnosis of PPB (type II) was finally confirmed by a CT-guided puncture biopsy of the active tumor tissue. This case highlights the critical role of 18F-FDG PET/CT in the diagnosis of PPB in children.