Carcinoma of Unknown Primary (CUP) in Female Presenting with Lower Back Pain: An Important Clinical Lesson
Jamie Hind*, Gur Aziz Sidhu, Chris Powell, Andrew Lacon, Neil Ashwood
Carcinoma of unknown primary (CUP) Malignancy of unknown origin is associated with high rates of morbidity and mortality. We report a case of a 33-year-old female, diagnosed with CUP, after presenting with gradual onset worsening lower back pain. Immunohistochemistry, blood tests, further investigations, and Multidisciplinary team meetings failed to identify the primary malignancy. This is not an uncommon pathway for patients with CUP. This report highlights how CUP can affect the quality of life of patients and how management for CUP should be focused on enhancing Quality of Life (QOL). It also addresses the difficulty of identifying which group of patients may benefit from further investigations to identify the primary and thus receive target treatment therapy.
Risk Factors Associated with Breast Cancer
Victor Manuel Vargas-Hernandez
Background: It is reported that genetic and hereditary-familial risk factors for breast cancer contribute 5% and the majority are related to the reproductive life of women. Objective: it has the purpose of determining if the factors considered as risk factors are associated with breast cancer in a group of Mexican women. Material and Methods: A retrospective, observational and descriptive study was carried out in 162 women with breast cancer for 3 years (2002-2004) at the Hospital Juárez de México to determine if the usual risk factors are related to breast cancer. The descriptive analysis included localization and dispersion measures, as well as a graphical analysis using bar diagrams. Results: In the sample of 162 women with breast cancer, the age range at the time of breast cancer diagnosis was from 27 to 78 years (mean of 47.60, standard deviation of 13.09); early menarche only appeared in 12.3% (n=20). The mean age of the first pregnancy was 22 years and of menopause at 51 years of age; 72.2% lactated (n=117) and 45.1% did so for more than 6 months (n=73); the menstrual pattern disorder appeared in 22.8% of cases (n=37); Menopausal hormone therapy was previously used in 19.8% (n=32). The hereditary-family history of breast cancer appeared in 14.2% of the cases (n=23). It seems to be correlated with the fact that in patients with nulliparity, alcoholism and the absence of breastfeeding, breast cancer occurs at an early age (< 45 years) and the risk factor that is related to breast cancer is overweight and obesity with 54.26% and 17.11% respectively (average of 28.00, standard deviation of 3.032). Conclusion: no correlation was found between risk factors considered common for breast cancer; only overweight and obesity were related to its development, further research is required to confirm whether this correlation occurs in other countries.
Krukenberg Tumor: A Review of Prognostic Factors and Management
Mayra Vallina Bocanegra, Ana Carolina Ortiz Sanchez, Julio Alberto Vásquez, Natalia Gabriela Sanchez, Adrian Murillo Zolezzi*
Aim: This review aims to summarize current evidence on Krukenberg Tumors (KT), addressing the main prognostic determinants and its’ management. Background: Krukenberg Tumors are rare metastatic tumors of the ovary. They were initially described by Friederich Ernst Krukenberg in 1896. They arise from extra-ovarian primary signet-ring cell carcinomas, being the gastrointestinal tract the most common site of origin. The most common clinical presentation of KT is an abdominal mass or discomfort in a premenopausal 40 to the 50-year-old woman. The prognosis is extremely poor compared to primary ovarian cancer. Results: Overall survival may vary significantly according to the choice and timing of treatment. The effective treatment strategies for KT are still controversial. However, therapeutic options include surgical resection as the mainstay of treatment when possible and the application of different Chemotherapy (CT) regimens. Conclusions: Several factors negatively affect prognosis: an incomplete metastasectomy, extensive disease at diagnosis and the origin of the tumor are the main factors that most authors agree incur in a worse prognosis. KT’s optimal therapeutic strategies are still a matter of debate, raising the need for more studies to achieve consensus.
Unusual Metastases Site of Thyroid Papillary Carcinoma: A Case Report and Review of the Literature
Hicham Ngham*, Bushra Abdulhakeem, Lyoubi Hicham, Omar Wydadi, Youssef Oukessou, Reda Allah Abada, Sami Rouadi,Mohammed Roubal, Mohammed Mahtar
Thyroid carcinoma with cranial scalp metastasis is an unusual site. Although these metastases have poor prognosis, early diagnosis and administration of accurate therapy using radioactive iodine seems likely to improve the survival rate and the quality of life. We report a case of a 50-years old woman presented to our ENT department with a slowly evolving lesion in the subcutaneous tissue of the skull occurred 10 years after right lobo-isthmectomy. The treatment was based on resection of the skull lesion as well as thyroid totalization and radioactive iodine
The Viscous Juncture-Juxta Articular Myxoma
Juxta-articular myxoma is an uncommon, benign, hypocellular, bland, myxoid neoplasm of mesenchymal origin occurring within the vicinity of a large joint such as the knee. The neoplasm is exemplified within 16 years to 83 years with a median age at 43 years. A male predominance is observed with a male to a female proportion of nearly 3:1. Localized tissue destruction arising on account of the neoplasm can engender pain or nerve palsy. The minimally cellular tumefaction depicts an abundant, myxoid stroma admixed with a non-malignant proliferation of spindle-shaped cells. Juxta-articular myxoma is immune reactive to vimentin and CD34.
Isolation and Enumeration of Circulating Tumor Cells (CTC) as Prognostic and Predictive Biomarkers in Post-Operative m-CRC
Prathibha KS, Swaroop G*
Circulating Tumor Cells (CTCs) presents non-invasive, repeatable investigation of patient‘s disease. In metastatic Colorectal Cancer (m-CRC) patients, CTC enumerations have been comprehensively studied in evaluating metastatic disease. CTC analysis has been shifting from enumeration to more sophisticated molecular depiction of tumor cells, which is used for liquid biopsy of the tumor, reflecting cytological and molecular changes in metastatic patients over time. In this study, CTC enumeration in advanced and localized metastatic colorectal cancer, highlights the vital gains as well as the challenges posed by various approaches, and their implications for advancing disease management. Detection of circulating tumor cells (CTC‘s) or circulating free tumor DNA (ctDNA) to conduct chemotherapy and reporting prognosis is extremely important, In view of the detail CTC has the potential to offer multiple samples by way of sequential minimally-invasive liquid biopsies. In fastidious, there is escalating evidence for the efficacy of CTC‘s in the clinical management of metastatic colorectal cancer (CRC). With most studies confirming the association of elevated CTC counts with worse prognosis. CTC‘s were first identified by Ashworth in 1869. CTC research has been vulnerable by the failure to constantly detect these typical cells. While the normal range of WBCs in human blood is 4.5-119/L, there may only be a few CTC‘s. The most widely used CTC enumeration platform, Cell-Search (Veridex LLC, NJ, USA) was approved for clinical use. As treatment options expand for metastatic colorectal cancer (mCRC), a blood marker with a prognostic and predictive role could guide treatment. Investigations were carried out that Circulating Tumor Cells (CTCs) could predict clinical prognosis in patients with mCRC. This pilot study, demonstrates that CTCs can serve as both prognostic and predictive factor for patients with mCRC. The presence of at least three CTCs at baseline and follow-up is a strong independent prognostic factor for inferior PFS and OS. When utilized in combination with imaging studies, CTCs provide additional prognostic information. There are several studies for which CTCs could have efficacy inmetastatic colorectal cancer. The statistics suggests that CTCs may be used as a stratification feature in metastatic disease treatment trials. The current list of validated prognostic factors is short, with only routine status being universally recognized. Further study should prospectively deal with modification of regimens based on unfavorable CTCs early in the course of treatment will result in enhancement in PFS or OS. As treatment has become more effective for metastatic disease, decision making has become more complicated. Five classes of drugs are on hand for treatment. The most common initial chemotherapy is a fluoropyrimidine with oxaliplatin or irinotecan. CTC levels drawn at 3 to 5 weeks and 6 to 12 weeks, before PET imaging, may lead to prospective regimen choices and standby patients from unnecessary drug toxicity by suggesting that an early change in treatment is defensible.