Multiple Paraneoplastic Neurological and Rheumatological Syndromes Revealing an Ovarian Cancer

Multiple paraneoplastic syndromes are a rare clinical manifestation. We describe the case of an 82-year-old woman who presented with neurological (rapidly progressive cerebellar syndrome and combined sensory-motor neuronopathy) and rheumatological (palmar fasciitis and polyarthritis syndrome) paraneoplastic syndromes associated with two onconeural antibodies (anti-Yo and Zic4), that revealed an ovarian cancer. The involvement of multiple organ systems should be a clue to take into consideration a paraneoplastic etiology that could permit early detection of cancer. However, despite the existence of treatments, the prognosis of these conditions remains poor.

Factors Influencing the Prognosis of Acute Myeloid Leukemia

Objective: To investigate the prognostic factors of adult acute myeloid leukemia (AML). Methods: A total of 51 patients with AML initially treated in Zhongda Hospital affiliated to Southeast University in the past 7 years were selected to investigate the gender, age (60-year-old) and WBC count (>=30*109/L), whether there is a history of MDS and other factors related to survival rate. Results: The results showed that age and the history of MDS prodrome were independent prognostic factors affecting OS. The OS rates of CD19 negative, CD11b positive and CD64 negative patients were significantly lower than those without the above factors at the onset of the disease, and the differences were statistically significant (all P<0.05). Conclusion: The prognosis of AML patients is affected by multiple factors, so prognosis should be stratified according to risk factors, and appropriate chemotherapy regimens should be selected for patients of different age groups.

In Search of a Histopathological Pattern of Immune-Mediated Gastritis from Nivolumab Therapy: A Case Report with Literature Review

Immunotherapy with checkpoint inhibitors is associated with termed inflammatory and immune-related side effects (irAE). Upper gastrointestinal symptoms are infrequent and appear mainly in patients on combination therapy with two checkpoint inhibitor drugs. We present the case of a patient with IIIB stage cutaneous melanoma treated with Nivolumab in monotherapy who developed an immune-mediated gastritis. Histopathologically, due to the paucity of published cases, no specific pattern of Nivolumab-immune-mediated gastritis has been described. We have reviewed the literature and compared the histopathology of the cases available in the literature.

Vitamin D Deficiency and Tumor Response Failure in Breast Cancer Patients Receiving Neoadjuvant Chemotherapy at a Medical Center in Mexico

Background: Vitamin D deficiency has been associated with not achieving a complete pathological response in patients with breast cancer after neoadjuvant chemotherapy. The objective of this study was to determine whether vitamin D deficiency is associated with tumor response failure in patients with breast cancer operated and who received neoadjuvant chemotherapy. Materials and Methods: This was a prospective, cross-sectional, analytical and observational study. Vitamin D was measured in patients with breast cancer who had received neoadjuvant chemotherapy and its association with tumor response was determined. For the inferential analysis, the Student’s t-test, chi-square test, and Fisher’s exact test were used. A p value <0.05 was considered statistically significant. Results: Thirty-six patients were included. There was tumor response failure to treatment in 69.3% and vitamin D deficiency occurred in 58.3%. No association was found between vitamin D deficiency and tumor response failure (p = 0.729), histological type (p = 0.691), molecular profile (p = 0.969), clinical stage (p = 0.468) or menopause status (p = 0.701). Conclusion: Vitamin D deficiency is not associated with tumor response failure in breast cancer patients who received neoadjuvant chemotherapy.

Biochemical and Molecular Diagnostic Indicators for Cancer

Biomarkers are substances that are either secreted by the tumor or produced by the body in response to the presence of cancer. Biomarkers serve as an objective measure for evaluation of normal and pathological processes as well as pharmacological responses to a therapeutic intervention. Cancer studies are usually difficult to interpret, especially based on the contemporary medical diagnosis. In this circumstance, biomarkers are developing as reliable diagnostic metabolites, which have many promising applications in oncological screening, differential diagnosis, risk assessment, response to treatment, and examining the progression of disease. Genome or protein based prognostic biomarkers are available, for numerous cancer types, for potential inclusion into clinical prognostic staging methods. However, there lies difficulty in translating these biomarkers into clinical outcomes. This review concerns important biomarkers related to wide varieties of cancer and also elucidates mode of action of few major biomarkers.

Platelet-Lymphocyte Ratio, Circulating Tumor Cells and Circulating Tumor Microemboli as Predictors of Thrombosis in Patients with Gastric Cancer

Background: Cancer-associated thrombosis (CAT) is a major cause of morbidity and mortality in oncology patients. There are no accurate risk assessment tools to predict venous thromboembolism (VTE). Circulating tumor cells (CTCs), circulating tumor microemboli (CTM), and high platelet-lymphocyte ratio (PLR) may predispose to VTE. Objective: To evaluate correlations of CTCs, CTM, and PLR with VTE and progression-free survival (PFS) in gastric cancer patients. Methods: Patients with gastric cancer were recruited (March 2016 to April 2017). CTCs were assayed by ISET at two timepoints: before neoadjuvant treatment (CTC1) and after surgery/before adjuvant therapy (CTC2) for patients with localized disease, and before first-line chemotherapy (CTC1) and after 6 months (CTC2) for patients with metastases. VTE incidence was determined retrospectively. PFS was estimated by Kaplan-Meier analysis. Results: We studied 93 patients. According to Khorana scores, 63 (67.7%) patients were at intermediate and 30 (32.3%) were at high risk for VTE. VTE incidence was 20.4% and CTM were found in 39.8%. VTE developed in 7/37 (18.9%) CTM-positive and in 11/50 (22%) CTM-negative patients (p=0.93). When PLR >288, VTE occurred in 7/14 patients (p=0.005). PLR also associated with poor PFS (p<0.0001). CTC2 was associated with poor PFS (p<0.0001). CTC2, PLR and VTE were independent prognostic factors for PFS (p=0.005, 0.043, and <0.0001 respectively). Conclusion: PLR is a prognostic indicator for PFS and for VTE in gastric cancer. Neither CTC, nor CTM improved risk stratification for VTE in our population.

A Rare Malignancy of Head And Neck Region: Sinonasal Undifferentiated Carcinoma

Sinonasal undifferentiated carcinoma is a rare malignancy of the head and neck region. Its diagnosis and treatment are difficult due to its rare and aggressive tumor nature and the complex anatomy of its localization. A 70-year-old male who presented with symptoms caused by this rare tumor was reported. The patient presented with pain on the left side of the head and vision loss in the left eye for 1 month, and his endoscopic biopsy was reported as undifferentiated carcinoma. This case report aimed to discuss the diagnosis and treatment of sinonasal undifferentiated carcinoma.

Establishing A Virtual Planning Protocol for Functional Maxillomandibular Reconstruction in Oral Cancer Patients

Background: Virtual surgical planning (VSP) helps optimize vascularized bone flap reconstruction and dental rehabilitation in maxillomandibular defects, improving accuracy, reducing errors and reducing the time required for surgery. In this manuscript, we describe a robust but flexible virtual protocol for functional maxillomandibular reconstruction optimized for oral cancer patients using in-house digital planning and provide templates to streamline communication among the team members. Methods: Based on our previous experience of VSP in oral cancer (n=17), we derived a workflow to improve efficiency. It included a virtual surgical template and a protocol focused on the minimal time requirements for three different reconstructive approaches: prefabrication/prelamination, primary implant placement using the SM-ART approach, and digital planning without primary implant placement. We performed a prospective validation (n=4) to determine its validity and if the proposed timelines could be adhered to. Results: The protocol allowed a smooth and coordinated framework for team members to communicate and plan the patient’s treatment. The time period required for VSP was described for patients undergoing bony reconstruction with primary dental placement in those with and without custom plates, drill guides and for patients with prefabrication (Rohner’s procedure). The minimum time required for VSP ranged between 17 and 30 days. The protocol could be reliably applied to the prospective group without any modification. Conclusion: Bony reconstruction with primary dental implant placement in the context of oral cancer can be performed successfully with good functional outcomes. By adopting this protocol, virtual surgical planning can be performed efficiently, avoiding potentially costly delays in treatment.

The Potential of U6 and Its Copies in the Regulation of the Human Genome

Non-coding RNAs are conformed by a large repertoire of RNA molecules with unimaginable tridimensional structures and functions. Small nuclear RNAs are an essential part of the spliceosome machinery, which is crucial for proper mRNA maturation. It is important to add that U6, one of the four snRNAs forming the spliceosome has been extensively studied. Full-length U6 (U6-1) loci are widely dispersed throughout the genome (200-900 copies), but a few U6 full-length loci have been identified to date as potentially active genes. The importance of U6 to carry out, together with other snRNAs, the catalytic activity and recognition of annealing target sequences, its evolution in the genome and the fact that the genome has many U6 copies and pseudogenes, its association with retrotransposition, as well as their implication in diseases is discussed in this review.

A Randomized Trial to Maximize Identification and Genetic Counseling Referral of Women at Risk for Hereditary Breast and Ovarian Cancer

Purpose: The Breast Cancer Genetics Referral Screening Tool (B-RST™) has been endorsed as one of several validated screening tools to identify women appropriate for cancer genetics referral. We conducted a randomized trial to determine the most effective means of follow-up for women who screened positive on B-RST™ 3.0. Methods: Women undergoing screening mammography at one of four Emory clinics were approached to complete the B-RST™. Participants who screened positive were randomized to one of three follow-up groups: self-referral (Group 1), electronic health record (EHR) clinician messaging (Group 2), or direct contact (Group 3). We compared genetic counseling appointment scheduling and completion rates by group. Results: Of 2,422 participants, 658 (27.2%) screened positive. Genetic counseling appointments were scheduled by 9.2%, 20.1% and 9.7% of Group 1, 2 and 3 participants respectively (p=0.001). Challenges to scheduling included lack of physician response to EHR messages and unsuccessful direct contact. Among those scheduled (n=78) 70.5% completed the appointment, with no difference between the three groups. Conclusion: B-RST™ can be used effectively in mammography settings to identify high-risk women for cancer genetics referral. Follow-up via EHR appears an acceptable and efficient approach, but additional strategies are needed to facilitate completion of the genetic counseling process.