Introduction: Dermatofibrosarcoma protuberans (DFSP) is a rare soft tissue sarcoma that grows from the dermis and is most commonly found in the trunk and proximal extremities. It is characterized by frequent local recurrences and invasive growth. Despite its rarity, DFSP can occur in the breast. In this report, we describe the successful treatment of a rare case of DFSP of the breast that resulted in long-term disease-free survival. Case presentation: A 43-year-old Syrian woman diagnosed with a right breast mass and underwent a lumpectomy, which revealed DFSP. Subsequent imaging studies and biopsies excluded metastatic disease. Over the following years, the patient developed several benign breast, axillary, uterine, and flank lesions. At 6-year follow-up, she had no signs of local recurrence or metastasis. Conclusion: This case report highlights the importance of early diagnosis and appropriate management of DFSP, even in unusual locations such as the breast. 6 years follow-up remains essential to monitor for any recurrences.

Background: Regression of malignancy in the absence of cancer-directed therapy is an uncommon and poorly understood phenomenon. Its occurrence is particularly rare for pancreatic ductal adenocarcinoma (PDAC). The interaction between tumor and microenvironment may induce an immune response in which both innate and acquired immunity have been found to be implicated. An immunogenic tumor may promote antigen presentation and effector T cell activity, leading to cancer cell death and tumor inhibition. Case: We present the case of a 57-year-old man diagnosed three years ago with a borderline-resectable PDAC confirmed by biopsy. The patient received first-line 5-fluorouracil-based chemotherapy with progression of disease including new hepatic metastases. He then received twelve cycles of gemcitabine and nab-paclitaxel with successful reduction in the number and size of liver metastases. Upon patient request, a treatment holiday was initiated, during which his abdominal imaging showed continued tumor regression. After eleven months without any systemic therapy, there are no remaining metastases in the liver, and the primary pancreatic mass continues to recede. He currently remains on surveillance. Conclusion: Our patient’s rare clinical course raises questions including the optimal next steps in treatment, such as continued observation or local treatment such as surgical resection. The decision to continue observation results from our belief that minimal disruption of the tumor microenvironment (TME) may allow for continued control and cancer regression. More laboratory and clinical studies are imperative to understanding the physiological basis of sustained tumor regression after chemotherapy discontinuation and may impact real-world clinical decision-making. Additionally, the definition of spontaneous tumor regression may need revision to distinguish between prolonged therapeutic response and regression due to immunogenic features in the absence of prior therapy.

Introduction: Primary vaginal carcinosarcoma is extremely rare, with only 12 cases reported to date. A consensus has not been reached on the best treatment approach, as most patients undergo surgery; however, the disease is highly refractory. Case Presentation: We present the case of a 34-year-old woman diagnosed with vaginal carcinosarcoma after experiencing vaginal pain and bleeding. She opted for organ preservation and underwent definitive chemoradiotherapy (dCRT) using interstitial brachytherapy, receiving an initial concurrent chemoradiotherapy dose of 50 Gy in 25 fractions with weekly cisplatin. This treatment was followed by brachytherapy, in which 22.5 Gy was delivered in three fractions. To prevent vaginal stenosis, the patient was advised to undergo regular vaginal irrigation and to engage in sexual activity. At 25 months after treatment, the patient remained disease-free. The patient reported minimal impact on sexual activity, and her quality of life (QoL) was well maintained. Conclusion: To our knowledge, this is the first reported case of early-stage vaginal carcinosarcoma treated with dCRT. This suggests a promising treatment option for preserving organs. The prevention of vaginal stenosis following dCRT, in addition to organ conservation, is essential for preserving sexual function and QoL.

Introduction: Obinutuzumab is a standard treatment for CLL in combination with venetoclax, following the CLL 14 trial. The purpose of the gradual ramp-up dosing is to mitigate toxicity and prevent tumor lysis; while these ramp-up doses are considered active; they are not considered to be definitive therapy. We describe the case of a CLL patient who had an exceptional response to obinatuzumab in the ramp-up phase followed by limited venetoclax. Case Report: A 73-year-old female with CLL, with Trisomy 12 (70.5%), deletion of 13q (14%), and 3 copies of 11, who had been monitored for ten years, developed bulky disease, and treatment was initiated following CLL 14. On cycle 1 day 1 (C1D1) she was treated with 100mg of Obinutuzumab; she received 900mg on C1D2. When she returned for treatment on C1D8 she was found to have profound pancytopenia, and obinutuzumab was held. She received no further obinutuzumab but was started on venetoclax and received 12 weeks of treatment, with maximum dose reached in ramp-up being 400mg daily. Further treatment was limited by cytopenias. Bone marrow biopsy within four months of treatment with total 1,000mg of obinutuzumab and ~13,000mg venetoclax, revealed trilineage hematopoiesis with only trace evidence of CLL at 0.14%. She was then treated with 4 weeks of rituximab for presumed immune thrombocytopenic purpura (ITP), and subsequent peripheral blood flow cytometry analysis revealed no evidence of CLL. The patient remains in complete remission 34 months following obinutuzumab therapy. Conclusion: The degree of pancytopenia and the exceptional clinical response to minimal dose of obinutuzumab by this patient suggests an unusual sensitivity to obinutuzumab.

Introduction: Pulmonary metastases from small-intestinal cancers are rare. This report describes a case of jejunal adenocarcinoma with metastasis to hilar lymph nodes. Case description: This case report presents the medical history of a 60-year-old male who sought medical attention for symptoms of fatigue and night sweats. Fiberoptic bronchoscopy revealed metastatic malignant tumors in the hilar lymph nodes. The patient underwent six cycles of etoposide + cisplatin (EP) chemotherapy combined with atezolizumab immunotherapy. During treatment, the patient developed symptoms of hemoptysis and melena. Further evaluation using small-bowel endoscopy revealed a malignant tumor in the jejunum. Conclusion: Small intestinal adenocarcinoma with pulmonary metastasis is rare and is associated with poor prognosis. This case underscores the importance of considering the small intestinal origin when evaluating pulmonary or mediastinal masses of unknown primary origin.

Background: Hormone receptor positive breast cancer is the most common subtype, accounting for approximately two thirds of all breast cancer cases. In the metastatic setting, first line treatment is comprised of endocrine therapy and a cyclin-dependent kinase 4 and 6 inhibitor. Ribociclib is the most used agent and has the highest risk of hepatotoxicity among the three currently available cyclin-dependent kinase 4 and 6 inhibitors. Case Presentation: We present a case of a 59-year-old post-menopausal female with metastatic hormone receptor positive breast cancer who started treatment with fulvestrant and ribociclib after progression on anastrozole. After the third cycle, she developed grade 3 transaminitis. Ribociclib was held and after no improvement in 28 days, she was treated with a six-day course of prednisone 1 mg/kg, with significant improvement in her liver enzymes. Rechallenge with a lower dose of ribociclib (200 mg) was attempted, however she again developed grade 3 transaminitis. This again required treatment with a short course of corticosteroids. Following normalization of her liver enzymes, she was rechallenged with abemaciclib with no recurrent hepatotoxicity. Conclusion: Ribociclib hepatotoxicity can be successfully treated with withdrawal of the medication and a short course of corticosteroids if liver enzymes do not improve following a 28-day withdrawal, highlighting a potential immune-mediated mechanism. Additionally, rechallenge with another cyclin-dependent kinase 4 and 6 inhibitor is a safe and effective strategy that should be considered.

Background Cetuximab is an effective therapy for unresectable locoregionally advanced head and neck cancer, but for patients with end-stage renal disease (ESRD), clinical trials seldom provide evidence for the efficacy and safety of them. Methods and Results We report this case of 46-year-old male patient with stage IVa tongue squamous cell carcinoma who is on maintenance hemodialysis for diabetic nephropathy. He tolerated the therapy well and had a stable disease of the carcinoma. We determined cetuximab concentration and showed that pharmacokinetics of cetuximab in this ESRD patient was similar to healthy subjects. Conclusion Cetuximab can be used safely and effectively in cancer patients with ESRD, and we have provided an example of pharmacokinetics of cetuximab in renal failure patient.

An adult woman with a remote history of childhood neuroblastoma at age two presented to the hospital with spinal cord compression. She was ultimately diagnosed with metastatic neuroblastoma 28 years following her initial diagnosis. The patient had previously been in sustained remission, was functional and actively working, and had undergone follow-up in a cancer survivorship clinic. To our knowledge, this is the longest reported period from remission of neuroblastoma to recurrence, as the patient was well into adulthood at the time of diagnosis. Moreover, she presented with florid disease, characterized by diffuse osseous, solid organ involvement and progressive cytopenia. She was treated with chemotherapy but developed multiple complications. This report illustrates an exceptionally rare late presentation of recurrent high-grade neuroblastoma, treatment course and clinical outcome.

[This corrects the article DOI: 10.1159/000546300.].

Introduction: Superior vena cava (SVC) syndrome is a well-recognized complication of thoracic malignancies, most commonly small-cell lung cancer. Endovascular stenting is preferred because it provides rapid symptom relief and restores venous patency. However, the role of post-stenting anticoagulation remains controversial, and complications related to its use are rarely reported. We describe such a case in a patient with malignant SVC syndrome. Case Presentation: A 51-year-old woman with small-cell carcinoma of the lung and SVC syndrome underwent stenting of the SVC. After the procedure, she was on prophylactic low-molecular-weight heparin and developed a large retroperitoneal hematoma with a significant decrease in hemoglobin on day four. The patient was managed with a transfusion and conservative care. Massive retroperitoneal hematomas secondary to anticoagulation therapy after SVC stenting are highly uncommon. Conclusion: There is currently no consensus guideline on post-stenting anticoagulation in malignant SVC syndrome. This case highlights one of the problems encountered in the post-stenting scenario of malignant SVC syndrome.