BackgroundSmall cell breast carcinoma (SCBC) is a rare, aggressive neuroendocrine breast cancer subtype comprising less than 1% of all breast malignancies. With no standardized treatment guidelines, management is typically extrapolated from small cell lung cancer (SCLC) or triple-negative breast cancer (TNBC) protocols. Immune checkpoint inhibitors (ICIs) have shown promise in both TNBC and SCLC, but their role in SCBC remains undefined.Case PresentationWe report the case of a 65-year-old woman diagnosed with early-stage, triple-negative SCBC, exhibiting high-grade features and a Ki-67 index >90%. She received neoadjuvant cisplatin and etoposide with pembrolizumab, followed by breast-conserving surgery and adjuvant pembrolizumab. Histopathology demonstrated a complete pathological response. The patient tolerated treatment well and remains disease-free on follow-up.ConclusionThis is the first reported case of SCBC successfully treated with neoadjuvant chemoimmunotherapy, achieving complete pathological remission. It highlights the potential role of ICIs in SCBC and supports future research into biomarker-driven strategies for this rare and aggressive.

Introduction: Tegafur/uracil (UFT) is a widely used oral adjuvant chemotherapy for non-small cell lung cancer. Severe hepatic toxicity is rare, and sinusoidal obstruction syndrome (SOS) has not been well characterized in this setting. [1–3]. Case Presentation: A 76-year-old man underwent thoracoscopic middle lobectomy for stage IA3 papillary adenocarcinoma of the right lung. Adjuvant UFT therapy was started 2 months postoperatively. Although liver enzymes were mildly elevated, treatment was continued. After 11 months of UFT, he developed abdominal distension and bilateral leg edema. Laboratory testing revealed severe hypoalbuminemia, coagulopathy, and marked increases in M2BPGi and hyaluronic acid. Viral hepatitis, autoimmune disease, metabolic liver disease, and cardiogenic hepatopathy were excluded. Contrast-enhanced CT showed pronounced hepatic atrophy, moderate ascites, and heterogeneous delayed-phase enhancement consistent with sinusoidal perfusion abnormalities. Because of ascites and coagulopathy, biopsy was contraindicated. The constellation of imaging, clinical course, and laboratory findings indicated drug-induced sinusoidal injury most consistent with UFT-related SOS. UFT was discontinued, and supportive management was initiated, including albumin, diuretics, and ursodeoxycholic acid. Liver function gradually improved, ascites resolved, and follow-up CT demonstrated partial restoration of hepatic volume over 6 months. Conclusion: This case represents the first reported instance in which UFT-induced hepatic injury was clinically, biochemically, and radiologically demonstrated to be consistent with sinusoidal obstruction syndrome. It highlights a rare but serious hepatic complication of UFT and underscores that careful monitoring of fibrosis markers and radiologic findings—not only liver enzymes—is essential for early detection of drug-induced sinusoidal obstruction syndrome during prolonged adjuvant chemotherapy.

Background: Epstein-Barr virus (EBV)-associated lymphoproliferative disorders (LPDs) present unique challenges in immunocompromised patients. Neurotoxic complications typically arise after prolonged exposure and tend to manifest as peripheral neuropathy. This case describes acute encephalopathy shortly after a brief course, an uncommon and severe adverse effect. Case Report: We describe a 17-year-old Hispanic male with EBV-associated LPD in the setting of complex autoimmune vasculitis and immunosuppression. Disease was unresponsive to multiple therapies including rituximab and chemotherapy, but eventually responded to a course of SMILE (steroid-dexamethasone, methotrexate, ifosfamide, L-asparaginase, etoposide). Brentuximab vedotin maintenance was initiated to secure remission. However, 7 days post-initiation, he developed culture-negative sepsis which progressed to acute encephalopathy and multiorgan failure. Infectious work-up along with Neurological evaluation, including imaging and cerebrospinal fluid analysis, did not identify an alternative etiology. Conclusion: This case highlights a rare instance of early brentuximab vedotin-induced encephalopathy and underscores the need for close neurological monitoring in high-risk patients.

Introduction Breast cancer is the most common malignant tumor in women, affecting approximately 1 in 9 women worldwide. In contrast, vulvar cancer remains rare, accounting for <1% of all cancers among women. Metastatic vulvar tumors are even rarer, constituting only 5 to 8% of all vulvar cancers. In some cases, breast cancer may metastasize to the vulva or vulvar tumors can arise from ectopic breast tissue. Case Report We report the case of a 78-year-old woman with vulvar metastasis of breast origin occurring 17 years after the diagnosis of primary breast cancer. The recurrence was identified by a PET scan concurrent with the patient reporting episodes of vaginal bleeding. Diagnosis was confirmed by clinical examination and biopsy. The proposed treatment was combined cyclin-dependent kinases 4 and 6 (CDK4/6) inhibitor abemaciclib and anti-estrogen agent fulvestrant. The patient demonstrated a good response, with a favorable clinical outcome as she is still in complete remission. Conclusion This case underscores the importance of long-term follow-up of hormone-sensitive breast cancer, including thorough clinical examinations. To the best of our knowledge, this is the first reported case of vulvar metastasis from breast cancer that was successfully treated with the combination of abemaciclib and fulvestrant, leading to a complete response. The use of CDK4/6 inhibitors for the treatment of vulvar metastases of breast origin represents a significant advance, offering a less invasive and potentially more effective alternative to current treatment protocols.

Immune checkpoint inhibitors (ICIs) are an important component of triple-negative breast cancer (TNBC) treatment, and the KEYNOTE-522 regimen has established pembrolizumab combined with chemotherapy, as the standard of care. While ICIs improve outcomes, they can also induce immune-related adverse events (irAEs), affecting diverse organs. However, renal, pancreatic, and ocular toxicities are rare, and there have been few reports of sequential multi-organ irAEs in breast cancer. This case study describes a 63-year-old woman with stage IIA TNBC who was treated with the KEYNOTE-522 regimen. During neoadjuvant therapy, she developed fever, malaise, and mild laboratory abnormalities. Her symptoms progressed to acute kidney injury and elevated pancreatic enzymes. She was diagnosed with immune-related acute interstitial nephritis and pancreatitis and improved promptly with high-dose corticosteroids. After tapering immunosuppression, the patient developed Pneumocystis jirovecii pneumonia. Subsequently, she suffered bilateral anterior uveitis consistent with an immune-related ocular event. Surgical resection revealed a pathological complete response (pCR), and she remains under surveillance. This case included three distinct irAEs affecting the kidney, pancreas, and eye. Each occurred at a different time point, including after discontinuation of immunotherapy. The opportunistic infection that she developed during steroid therapy emphasizes the need for prophylaxis in patients requiring prolonged immunosuppression. This case underscores the importance of multidisciplinary management and long-term vigilance for delayed and multi-organ irAEs in TNBC patients treated with ICIs.

Introduction: Primary lymphoma of the ampulla of Vater is an exceptionally rare entity, with most reported cases being low-grade B-cell lymphomas in adults. Diffuse Large B-Cell Lymphoma (DLBCL) at this site is markedly aggressive and exceedingly uncommon in the pediatric population. Case Presentation: An 11-year-old male presented with obstructive jaundice. Abdominal ultrasound revealed a dilated gallbladder. Endoscopic Retrograde Cholangiopancreatography (ERCP) identified a fungating mass at the ampulla of Vater, causing significant biliary dilation. Histopathological and immunohistochemical analysis of biopsy samples (positive for LCA and CD20, negative for CD3) confirmed the diagnosis of DLBCL. Staging CT scan showed localized disease with cervical lymphadenopathy. The patient was managed with biliary stenting and systemic immunochemotherapy (R-COP protocol). Following an episode of hepatotoxicity, doxorubicin was introduced. Post-treatment imaging showed an excellent therapeutic response, and the patient was scheduled for consolidative radiotherapy. Conclusion: This case underscores that lymphoma, though rare, should be considered in the differential diagnosis of obstructive jaundice even in children. A multimodal approach involving ERCP with biopsy and imperative immunohistochemistry is crucial for an accurate diagnosis to avoid unnecessary surgery. Management centered on immunochemotherapy, with adjuncts like biliary decompression and radiotherapy, can lead to successful outcomes in pediatric ampullary DLBCL.

Introduction: Neurological immune-related adverse events (n-irAEs) caused by immune checkpoint inhibitors (ICIs) are rare but can be life-threatening. Case Presentation: A 43-year-old man with stage IVB squamous cell carcinoma of the lung developed progressive polyradiculoneuropathy 180 days after the first pembrolizumab administration. Initial treatments with high-dose corticosteroids and intravenous immunoglobulin (IVIg) were ineffective. Cerebrospinal fluid (CSF) analysis revealed albuminocytologic dissociation, and magnetic resonance imaging (MRI) revealed cervical nerve root hypertrophy. Plasma exchange (PE) was initiated along with steroid maintenance, resulting in gradual neurological recovery, as evidenced by improvements in the MRC score (from 32 to 56, on a scale from 0 to 60, with higher scores indicating greater muscle strength) and resolution of MRI abnormalities. Tumor control was sustained throughout the treatment. Conclusion: This case highlights the potential efficacy of combining plasma exchange and steroid maintenance therapy in managing severe, refractory n-irAEs without compromising oncologic outcomes.

Introduction Gastric-type endocervical adenocarcinoma (GTEC) is an uncommon and aggressive variant of endocervical adenocarcinoma, notable for its lack of association with human papillomavirus (HPV). It often presents late in its clinical course, leading to diagnostic challenges as it may mimic other gynecologic malignancies. Case Presentation This case report details the clinical course of a 63-year-old female patient who presented with a two-month history of lower abdominal pain, abdominal distention, constipation, and post-coital bleeding. These symptoms are atypical for GTEC, in which patients typically experience a mucus-like or watery vaginal discharge. A comprehensive diagnostic workup revealed elevated serum levels of Cancer Antigen (CA) 125 and CA 19-9. Cervical and vaginal biopsies subsequently confirmed a diagnosis of moderately differentiated adenocarcinoma, supported by immunohistochemical analysis that demonstrated strong positivity for CK7, CEA31, HIK1083, and HNF1-β, while showing negativity for p16, estrogen receptor (ER), and p53. Despite her relatively short symptomatic clinical course, the patient exhibited signs of advanced disease, characterized by peritoneal carcinomatosis, vaginal involvement, and obstructive uropathy from pelvic mass effect. Conclusion This patient's atypical clinical presentation illustrates that GTEC may mimic ovarian-like tumors, resulting in misclassification and diagnostic delay, and further underscoring the challenge that HPV-independent tumors such as GTEC pose to current screening strategies and diagnostic frameworks.

Background: Rhabdomyosarcoma (RMS) is the most common soft-tissue sarcoma in children and adolescents, but primary RMS of the breast is exceptionally rare and diagnostically challenging. Imaging findings are nonspecific and can mimic benign adolescent lesions (e.g., fibroadenoma), making timely histopathologic confirmation crucial. Immunohistochemistry for muscle markers—particularly Desmin and Myogenin—supports definitive diagnosis of embryonal RMS (ERMS). Case Presentation: A 14-year-old Arab female presented with a rapidly enlarging left-breast mass and ipsilateral axillary lymphadenopathy. Core biopsy showed small round blue cells with rhabdomyoblastic differentiation; tumor cells were Desmin- and Myogenin-positive, consistent with ERMS. She received six cycles of MAID chemotherapy, followed by local recurrence; one cycle of ICE achieved ~50% partial response but was complicated by cystitis and rapid radiologic progression. After three cycles of VAC, she underwent total mastectomy with lymph-node dissection. Restaging FDG-PET/CT demonstrated local recurrence and nodal metastases (bilateral axillary, subpectoral, internal mammary) with pulmonary nodules. Despite multimodal therapy, the disease remained refractory and the patient ultimately died of complications from metastatic RMS. Case Discussion: This case highlights the aggressive biology of primary breast ERMS in adolescents and the risk of early recurrence and dissemination despite intensive therapy. While standard management of RMS is multimodal—systemic chemotherapy with surgical resection and/or radiotherapy—responses can be transient, and treatment interruptions (e.g., toxicity-related delays) may jeopardize disease control. The diagnostic value of Myogenin (highly specific for rhabdomyoblastic differentiation) and Desmin was pivotal here, while the clinical course underscores the limitations of currently available regimens (MAID, ICE, VAC) for refractory disease at this uncommon site. Conclusion: Primary embryonal RMS of the breast is rare and highly aggressive, with a strong propensity for local recurrence and metastatic spread. Even with aggressive multimodal therapy, outcomes can be poor. Earlier recognition, rigorous treatment delivery, and development of novel strategies are urgently needed to improve survival in this devastating presentation.