History Of Cancer Research Articles

Metastatic Hobnail Papillary Thyroid Carcinoma Initially Diagnosed by Pleural Effusion: Case Report of a Rare and Intriguing Entity.

Hobnail papillary thyroid carcinoma (HNPTC) is an unusual and aggressive variant of PTC. Malignant pleural effusion secondary to thyroid carcinoma is a rare event reported in less than 1% of cases. Herein we present a case of metastatic HNPTC initially diagnosed by pleural effusion cytology, with a very poor outcome. A 42-year-old male with no previous cancer history, presented with an anterior neck mass growing for the past year. A computed tomography (CT) scan revealed a large complex cystic lesion with mass effect on the anterior thyroid gland, along with multiple neck and mediastinal necrotic lymph nodes, suspicion for metastasis. CT of the thorax showed lung nodules and a large left pleural effusion. Fluid was drained and sent for cytologic examination which revealed malignant cells predominantly in a micropapillary pattern with apically placed, bulged, "hobnail-like" appearance; intranuclear pseudo-inclusions or chromatin clearing was not seen. Based on cytomorphologic findings and immunohistochemical results (CK7 and PAX-8 positive; TTF-1, Napsin-A, and mesothelial markers negative), final diagnosis of HNPTC metastatic to pleural fluid was made. Fine-needle aspiration of neck mass showed similar cytomorphologic findings, confirming a thyroid origin. However, the patient experienced complications, rapid deterioration and died 6 months after diagnosis. The intersection of clinical-radiologic findings, cytology, and immunohistochemistry guided the identification of this rare variant of PTC as the origin of the malignant pleural effusion. We believe this case provides a valuable insight into the complexities involved in the diagnosis of thyroid carcinoma and emphasizes the significance of proper identification of rare variants.

P-836. Non-Beta Lactam Agents for Definitive Treatment of Ampicillin-Susceptible Enterococcus Bacteremia: A Single Center Experience

Abstract Background Enterococcus bacteremia (EB) is a serious infection with high morbidity and mortality. While anti-enterococcal beta-lactams (BL) remain the mainstay of therapy against ampicillin-susceptible (AS) EB, non-beta-lactam (NBL) antimicrobial agents are also used to treat ASEB. Few studies evaluate NBL use for definitive therapy of ASEB. CONSORT flow diagram of patients included in study. Methods A single-center retrospective study identified all ASEB episodes between 1/1/2016-12/31/2021 (Figure 1). Patient, microbiological, infection, treatment and outcomes were compared between those who received NBL versus BL for ASEB. Multivariable logistic regression analysis was used to determine factors associated with NBL use. Baseline characteristics of patients treated with non-beta-lactam vs beta-lactam for definitive therapy for ampicillin-susceptible Enterococcus bacteremia. Results 158 episodes of ASEB in 153 patients were included (Table 1). 43 episodes (27%) were treated with NBL for definitive therapy. Factors associated with NBL therapy were younger age (58 vs 66 years old, p=0.02), reported history of any penicillin allergy (42% vs 9%, p< 0.01) and serious penicillin allergy (14% vs 1%, p< 0.01), history of cancer (37% vs 17%, p=0.01), end-stage renal disease (ESRD; 23% vs 3%, p< 0.01), unknown source of bacteremia (24% vs 8%, p< 0.01), polymicrobial bacteremia (40% vs 16%, p< 0.01), lack of metastatic foci of infection (12% vs 31%, p=0.02), and lack of endocarditis (7 vs 23%, p=0.02). Combination therapy was used in 23% of those treated with BL therapy compared to no patients receiving NBL therapy (p< 0.01). For NBL vs BL therapy, there was no difference between all-cause 30-day mortality, all-cause 90-day mortality, or 30-day relapse rate. In a multivariable logistic regression model (Table 2), NBL therapy was more likely in those with: younger age (AOR 0.95, p=0.001), any penicillin allergy (AOR 5.76, p=0.001), history of cancer (AOR 5.23, p=0.001), ESRD (AOR 11.70, p=0), and polymicrobial bacteremia (AOR 4.20, p=0.001). Factors associated with use of non-beta-lactam antibiotic for definitive therapy of ampicillin-susceptible Enterococcus bacteremia: multivariable analysis. Conclusion NBL was used as definitive treatment in 27% of ASEB. Penicillin allergy, access and dosing for patients on hemodialysis, younger host, and polymicrobial infection are factors associated with NBL use. This real-life experience suggests NBL can be successfully used to treat non-severe ASEB. Further studies are needed to determine the efficacy and stewardship implications of NBL use for ASEB. Disclosures All Authors: No reported disclosures

P-447. Anal Pap Smear Trends in Patients Living with HIV and History of Malignancy in a Single-Center Retrospective Observational Study

Abstract Background The elevated rates of squamous cell carcinoma of the anus (SCCA) in persons living with HIV (PLWH) have led to greater awareness for screening with anal Pap cytology. While there is a premise that higher states of immunosuppression carry a greater risk of developing SCCA, no current studies describe this in the setting of PLWH with a history of solid or hematologic malignancy. The objective of this study is to review outcomes of anal Pap screenings in PLWH and a history of either solid or hematologic malignancies. With this study, we aim to outline potential risk factors associated with anal dysplasia in PLWH and a history of cancer. Methods This single-center retrospective cohort study included patients ≥ 18 years of age with a history of solid or hematologic malignancy who were followed at a cancer center clinic for HIV care between 2020-2024 and underwent anal Pap screening during this period. Demographics, pathology results, and clinical characteristics were obtained by chart review. Results The study identified 12 patients to date, with a mean age of 51 and male-to-female ratio of 5:1. Abnormal cytology on anal Pap was present in 83.3% (n=10) of patients with 50% (n=5) of these abnormal screenings resulting in either high-grade squamous intraepithelial lesion (HSIL) or atypical squamous cells, cannot rule out high-grade squamous intraepithelial lesion (ASC-H). Most with abnormal cytology on anal Pap underwent high-resolution anoscopy (HRA) (n=7/10). High-grade cytology was present on biopsy in 57.1% of patients (n=4/7). Invasive SCCA was found during HRA in 1 patient who had ASC-H on anal Pap screening. Table 1 outlines demographic information and clinical characteristics. Figure 1 demonstrates cytology results. Conclusion Over 75% screened had abnormal cytology, emphasizing the high incidence of anal dysplasia in this set of PLWH and a history of malignancy. The percentages of abnormal cytology in this population with a history of malignancy appeared to be higher than in other studies, implying chronic ongoing immune activation, although future work to expand the cohort is needed for robust estimation. These results should prompt further investigation to understand the potential interplay of HIV and malignancy history on the risk for developing anal dysplasia. Disclosures All Authors: No reported disclosures

P-2043. Outpatient Antiviral Treatment Among High-risk Patients with Mild to Moderate COVID-19 During the Omicron Surge

Abstract Background In response to the COVID-19 pandemic, outpatient treatment with oral antiviral medications has emerged as a crucial strategy to manage the disease effectively. This study aimed to evaluate the clinical outcomes of such treatment modalities in a cohort of confirmed COVID-19 patients. Methods This is a retrospective study of COVID-19 cases with high risk diagnosed during an Omicron wave from May 2022 to December 2022 in Taiwan. Cases received either nirmatrelvir-ritonavir (NMV/r) or molnupiravir (MOV) as outpatient treatment were enrolled to assess the clinical effects of therapeutic strategies. The 30-day crude mortality and hospitalization were the primary endpoint. Results Among 2932 patients with prescriptions of antiviral agents, 1395 patients received NMV/r, and 1537 received MOV. The average age of the patients was 63.8 years, with a majority (59%) being over 65 years old. Common comorbidities included diabetes (24.7%), chronic kidney disease (20.7%), cardiovascular diseases (17.6%), and a history of cancer (15.6%). The overall hospitalization rate was 15%, with a mortality rate of 0.7% which revealed promising clinical outcomes with outpatient treatment using either NMV/r or MOV. Compared with NMV/r, those on MOV were older (59.6 ± 18 years vs 67.4 ± 15 years, p< 0.001) and the proportion of cardiovascular disease (8.7% vs 19.5%) and chronic kidney disease (4.1% vs 28.5%) were higher. COVID-related 30-day hospitalization rate and mortality were higher in the MOV group significantly (15.5% vs 8.5%, p < 0.001; 0.8% vs 0.4%, p< 0.0001). Conclusion Outpatient treatment with NMV/r and MOV demonstrated effectiveness in reducing hospitalization and mortality rates among COVID-19 patients. Therefore, selecting outpatient treatment with these antiviral medications could represent an effective strategy for managing COVID-19, contributing to improved patient outcomes and reduced hospitalization needs. Disclosures All Authors: No reported disclosures

Partners' Perspectives on the Impact of Cancer on Romantic Relationships and Marriage in Adolescent and Young Adult Cancer Survivors.

Purpose: This study aims to explore the impact of cancer on romantic relationships and marriage from the perspective of partners of adolescent and young adult (AYA) cancer survivors. Methods: Semistructured interviews were conducted with 10 partners, of any gender and cancer type, who entered into a relationship or decided to marry after the AYA's cancer diagnosis. Results: Three key themes emerged regarding the impact of cancer on romantic relationships and marriage: no change or impact, positive impact, and anxiety. Negative impacts were rarely reported, although some participants suggested that, had the illness been more severe or active at the time they met, they might have hesitated to commit or marry. Positive impact included respect for cancer survivors and a sense of fulfillment from having overcome the disease together. Conclusion: Partners of AYAs generally accepted the disclosure of the survivor's cancer history without distress and demonstrated supportive attitudes. There were few negative effects on relationships or marriage, and no differences in impact were found based on cancer type. Cultural differences were noted in attitudes toward having children, in contrast to findings from studies conducted in Western countries.

P-726. "Infectious Complications in Patients with Relapsed/Refractory Multiple Myeloma Undergoing Novel Bispecific Antibody Therapy: A Myeloma-Infectious Disease Database Initiative"

Abstract Background Novel bispecific antibody (BsAb) therapies that target both CD3 and BCMA have been approved for the treatment of relapsed/refractory multiple myeloma (R/R MM). However, this therapy has been associated with a high rate of infectious complications. Further studies are needed to determine if this is due to underlying immunosuppression from prior therapies or related to the cellular therapy. Herein, we aimed to compare the incidence, etiology, and severity of infectious complications in patients with R/R MM treated with BsAbs, chimeric antigen receptor T cell (CAR T cell) or standard of care (SOC) after six months of therapy. Demographics and VariablesTable 1:Relapsed/Refractory multiple myeloma patient characteristics at initiation of therapy of interest. Methods We performed a retrospective study to include all R/R MM patients who underwent treatment at our center from January 2023 to June 2023. Patient demographics, cancer history and treatment related complications were reviewed. Therapy of interest included: a) BsAbs (teclistamab) or b) CAR T cell therapy (ciltacabtagene autoleucel or idecabtagene vicleucel), and c) non-cellular therapies (SOC). Our primary outcome of interest was incidence, severity, and timing of bacterial, fungal and viral related infections. Infectious ComplicationsTable 2:Rate and time of bacterial, fungal, viral, and pneumocystis related infections in relapsed/refractory multiple myeloma patients undergoing therapy with cellular and non-cellular agents. Results A total of 118 patients underwent treatment for R/R MM from January 2023 to June 2023. Six patients did not receive a therapy within our inclusion criteria; therefore 112 patients were included in the preliminary analysis; 24 had received BsAb, 32 received CAR T cell and 56 underwent treatment under SOC (Table 1). Hypogammaglobinemia was higher in BsAb recipients (Table 1). Patients receiving BsAbs had a higher rate of any viral infections compared to the CAR T cell and SOC groups (71% vs 59% vs 36%, p< 0.01; table 2). Time to viral infection after therapy was sooner in the BsAbs and CAR T cell therapy group compared to SOC (Table 2 and figure 1). There was no difference regarding the occurrence of bacterial or fungal infections between the groups. Time to First Viral InfectionFigure 1:Kaplan-Meier curve comparing time to first viral infections after therapy in relapsed/refractory multiple myeloma patients undergoing treatment with bispecific antibodies (blue), chimeric antigen receptor T cell (red) and non-cellular standard of care (green). (Log Rank of < 0.01) Conclusion Based on our preliminary analysis, R/R MM patients receiving BsAbs have a higher rate of viral infections when compared to CAR T cell therapy and standard of care treatment. Future analysis to understand independent risk factors for infection is planned once the cohort is expanded. Disclosures Fareed Khawaja, MBBS, Eurofins Viracor: Grant/Research Support|Symbio: Grant/Research Support Hans C. Lee, MD, Abbvie: Advisor/Consultant|Allogene Therapeutics: Advisor/Consultant|Bristol Myers Squibb: Advisor/Consultant|Bristol Myers Squibb: Grant/Research Support|Genentech: Advisor/Consultant|GlaxoSmithKline: Advisor/Consultant|GlaxoSmithKline: Grant/Research Support|Janssen: Advisor/Consultant|Janssen: Grant/Research Support|Regeneneron: Advisor/Consultant|Regeneneron: Grant/Research Support|Sanofi: Advisor/Consultant|Takeda Pharmaceuticals: Advisor/Consultant|Takeda Pharmaceuticals: Grant/Research Support Krina Patel, MD, Abbvie: Advisor/Consultant|Arcellx: Advisor/Consultant|Astra Zeneca: Advisor/Consultant|BMS: Advisor/Consultant|BMS: Scientific committee/chair|Caribou Sciences: Advisor/Consultant|Celgene: Advisor/Consultant|Genentech: Advisor/Consultant|Janssen: Advisor/Consultant|Kite: Advisor/Consultant|Kite: Scientific committee/chair|Merck: Advisor/Consultant|Oricel: Scientific committee/chair|Pfizer: Advisor/Consultant|Regeneron: Advisor/Consultant|Sanofi: Advisor/Consultant Roy F. Chemaly, MD/MPH, AiCuris: Advisor/Consultant|AiCuris: Grant/Research Support|Ansun Pharmaceuticals: Advisor/Consultant|Ansun Pharmaceuticals: Grant/Research Support|Astellas: Advisor/Consultant|Eurofins-Viracor: Grant/Research Support|InflaRX: Advisor/Consultant|Janssen: Advisor/Consultant|Karius: Advisor/Consultant|Karius: Grant/Research Support|Merck/MSD: Advisor/Consultant|Merck/MSD: Grant/Research Support|Moderna: Advisor/Consultant|Oxford Immunotec: Advisor/Consultant|Oxford Immunotec: Grant/Research Support|Roche/Genentech: Advisor/Consultant|Roche/Genentech: Grant/Research Support|Shinogi: Advisor/Consultant|Takeda: Advisor/Consultant|Takeda: Grant/Research Support|Tether: Advisor/Consultant

Constructing TheKeep.Ca With Thrivers of Cancer in Manitoba, Canada, in Support of Enhancing Patient Engagement: Protocol for a Pragmatic Multimethods Study.

TheKeep.Ca was built to facilitate engagement with those experiencing cancer in Manitoba, Canada. Constructed between 2020 and 2024 with a group of patient advisors, the website includes information on engagement activities including research participation, the patient advisor role, and how those experiencing cancer can access these Manitoba activities. A link allows visitors to register to be contacted about activities that match their demographics, cancer history, and activity preferences. After TheKeep.Ca was constructed, this protocol was developed to establish TheKeep.Ca as a platform for scientific research focused on optimally engaging those experiencing cancer. We asked the following questions: (1) What was the patient advisors' experience who participated in developing TheKeep.Ca? (2) What are the baseline characteristics of website traffic and registrants at TheKeep.Ca? (3) How does registering with TheKeep.Ca impact the cancer experience? The planned launch date for the website and initiation of research activities is January 2025. For objective 1, the active patient advisors (N=6) participating in the website project will be invited to participate in project activities including with responses to a question prompt sheet, semistructured audio-recorded interviews, or both. Responses and interviews will be analyzed using reflexive thematic analysis to understand and inform practices for patient engagement on projects. At the website launch, TheKeep.Ca will become publicly accessible and indexable on internet search engines, but no additional promotional interventions will take place in the initial 6 months resulting in visitors primarily from web search traffic. For objective 2, Google Analytics and website registrant data collected during the first six months will be analyzed to obtain baseline characteristics of website visitors. For objective 3, an online survey will be emailed to registrants six months after the website launch characterizing their website experience, the activities they participated in, and collecting feedback on the website. For objectives 2 and 3, quantitative data will be analyzed using both descriptive and inferential statistics, and qualitative data from open-ended questions will be analyzed using thematic analysis guided by an inductive descriptive semantic approach. This study was approved by the University of Manitoba Health Research Ethics Board on December 12, 2024 (HS26614-H2024L263). Institutional approval from CancerCare Manitoba is pending as of December 23, 2024. Findings from objective 1 are expected to be finalized within the first six months after the website launch. Those from objectives 2 and 3 are expected by the 12-month mark. Reporting will include peer-reviewed journals, conferences, and a lay-language summary on TheKeep.Ca. The research outlined in this protocol will facilitate understanding patient advisors' experience in developing TheKeep.Ca. It will also characterize the website' effectiveness and its impact on the cancer experience, providing a baseline and direction for future research and development. PRR1-10.2196/63597.

Family History of Colorectal Cancer is the Risk of Colorectal Neoplasia: Some Issues to Be Addressed.

Family History of Colorectal Cancer is the Risk of Colorectal Neoplasia: Some Issues to Be Addressed.

Changes in hormone receptor when breast cancer metastasizes to the colon: case report and literature review

The metastasis of breast cancer to the colon is a rare occurrence, especially in the presence of changes in estrogen and progesterone receptors. To date, literature has only reported two cases of invasive ductal carcinoma and two cases of invasive lobular carcinoma metastasizing to the colon with concurrent changes in hormone receptors. This report describes a 65-year-old woman with a history of left breast cancer, who presented with symptoms of bloody stools and abdominal pain. CT and colonoscopy results revealed a malignant tumor in the ascending colon, and the patient underwent surgery. Pathological results post-surgery indicated changes in hormone receptors, differing from the previous breast cancer pathology, ultimately leading to the diagnosis of breast cancer metastasis to the colon. The patient was found to have liver metastasis 14 months after right hemicolectomy, and systemic metastases in various locations were discovered at the 19-month mark.

Confocal Endomicroscopy Intestinal Epithelial Barrier Abnormalities in Individuals Without Documented Gastro-Intestinal Disease.

Probe-based confocal endomicroscopy (pCLE) allows real-time microscopic visualization of the intestinal mucosa surface layers. Despite remission achieved through anti-tumor necrosis factor or vedolizumab therapy, anomalies in the intestinal epithelial barrier are observed in inflammatory bowel disease (IBD) patients. Our study aimed to assess these abnormalities in non-IBD individuals and compare them with IBD patients in endoscopic remission to identify the associated factors. The study involved 84 patients, 40 with IBD under biologic therapy for over 6months and in endoscopic remission, and 44 without IBD or irritable bowel syndrome (IBS) undergoing colorectal screening colonoscopy. White light endoscopy and probe-based confocal laser endomicroscopy were performed in the ileum, right colon, transverse colon, left colon, and rectum. Demographic, clinical, biological, and morphological factors were examined. pCLE revealed abnormalities in both non-IBD individuals and those with IBD in endoscopic remission, such as fluorescein leakage, blood vessel dilatation, and hypervascularization across all segments, as well as epithelial gaps in the ileum, and crypt dilatation in the colon. Comparing the two groups, IBD patients exhibited slightly more gaps in the ileum, increased fluorescein leakage in the transverse colon, and fewer vessel dilatation in the transverse colon. Abnormalities were more frequent in cases of hypertension (p=0.03), dyslipidemia (p=0.02), female gender (p=0.02), selective serotonin reuptake inhibitor (p=0.03), and family history of IBD (p=0.04) or colorectal cancer (p=0.03). Confocal endomicroscopy abnormalities are present in both non-IBD individuals undergoing colorectal cancer screening colonoscopy as in those with IBD in endoscopic remission. Further research is needed to understand the pathophysiological mechanisms of these abnormalities and their clinical impact.

Factors influencing role preferences in decision-making of healthy women with BRCA1/2 pathogenic variants: subanalysis from a randomised controlled decision coaching trial

BackgroundPatients who actively engage in their medical decision-making processes can experience better health outcomes. This exploratory study aimed to identify predictors of preferred and actual roles in decision-making in healthy women with BRCA1/2 pathogenic variants (PVs).MethodsWomen with BRCA1/2 PVs without a history of breast and/or ovarian cancer were recruited in six centres across Germany. Those returning the baseline questionnaires (T1) were randomly assigned to the intervention or control group (IG, CG). The IG completed a decision-coaching (DC) programme, the CG received standard care. A second survey (T2) followed after 12 weeks. Ordinal regression analyses were performed. Sociodemographic and outcome-related baseline variables were used to identify predictors of (i) desired role at T1 in the total group and (ii) actual role at T2 in the CG and the IG. Role preferences were measured with the Control Preferences Scale.Results389 women completed the baseline questionnaires, 191 were randomised to the CG and 198 to the IG. At T1, high decisional conflict (OR 1.016, 95% CI 1.001–1.023, p = 0.038) and a negative self-concept (OR 1.030, 95% CI 1.008–1.054, p = 0.009) were significant predictors for preferring a more passive role. At T2, high baseline decisional conflict significantly predicted taking a more passive role in the CG, whereas in the IG, baseline decisional conflict showed no influence. Furthermore, in the IG, younger age (OR 1.049, 95% CI 1.001–1.098, p = 0.044) and a non-academic education (OR 0.46, 95% CI 0.213–0.775, p = 0.006) were identified as significant predictors for taking a more active role.ConclusionsHigh initial decisional conflict was identified as an important predictor for preferring and taking a passive role in decision-making among women with BRCA1/2 PVs. Participating in the DC programme can counteract passivating effects of an initially high decisional conflict and particularly support younger PV carriers and those with lower educational status to take an active role. With this profile, the DC programme expands the existing counselling and care concept to include a measure that can also specifically cover the support needs of younger women and those with a lower education level.Trial registrationDRKS-ID: DRKS00015527. Registered 30/10/2019.

Quality of Life After Alloplastic vs. Autologous Breast Reconstruction: 'The Influence of Patient Characteristics on Outcomes'

Objective: Quality of life (QoL) following autologous breast reconstruction has been found to be higher compared to alloplastic breast reconstruction. However, evaluating QoL is complex, as it is influenced by various factors, including patient characteristics and treatment types. Previous studies comparing QoL between reconstruction techniques have not sufficiently addressed baseline differences between patient groups, some of which contribute to indication bias. Using an alternative approach to identify the confounders, this study aims to evaluate which factors affect the patient satisfaction and QoL after alloplastic or autologous reconstruction, with follow-up extending up to three years post-surgery. Method: QoL and satisfaction were measured using the Breast-Q preoperatively, and after breast reconstruction( post-BR) at six weeks, six months, one year, and three years. General and mental health were measured using the SF-36 and the HADS. A generalized linear mixed model was utilized to assess which factors confound the relationship between reconstruction technique and Breast-Q scores. Results: Factors contributing to the disparity in Breast-Q scores between autologous and alloplastic breast reconstruction varied across Breast-Q subscales. Autologous breast reconstruction patients consistently reported higher “Satisfaction with Breasts” and “Physical Well-being”, while the minimal important differences in “Psychosocial” and “Sexual Well-being” were lost after adjustment for confounding factors. Conclusion: This study confirms that even when adjusted for confounders, scores on two QoL sub-scales autologous breast reconstruction patients score significantly higher over time. Although autologous reconstruction remained superior regarding “Satisfaction with Breasts”, scores decreased in autologous reconstruction patients when they were depressed at baseline, underwent radiotherapy, had a history of breast cancer, or faced major complications.

P-13 EXTRANODAL LYMPHOMA WITH ENDOCRINE ORGAN INVOLVEMENT: CASE REPORTS

Abstract Introduction The incidence of extranodal lymphomas has increased in the last decade, most commonly occurring in the gastrointestinal tract, head and neck, skin/soft tissue and central nervous system. We report two cases of extranodal lymphoma in the thyroid and adrenal gland. Clinical Cases A 61-year-old male patient diagnosed with Small Lymphocytic Lymphoma (CLL) was referred to us after his follow-up at the Hematology Clinic. Thyroid ultrasonography (USG) revealed a nodular ovoid lesion, that has a semisolid structure of 36x12 mm in size, with a cystic component in the center, located at the right lobe - isthmus junction, and with increased vascularity. Laboratory tests were as in Table 1. It was learned that the patient had received chemotherapy for CLL in 2009 and was in remission, and there was no family history of thyroid cancer. Since the fine needle aspiration biopsy (FNAB) was suspicious for lymphoid neoplasia, a tru-cut biopsy was performed. The flow cytometry result was found to be compatible with B-cell clonality, and the pathology result revealed mature B-cell neoplasia infiltration. Immunohistochemically, dense plasma cells were observed with CD138. Thyroidectomy was recommended to the patient, but he refused and was followed up. A 73-year-old female patient was referred to our clinic with the suspicion of adrenal insufficiency due to ongoing nausea, vomiting, and hypotension symptoms. Laboratory tests at presentation were as shown in Table 2. The patient was started on 80 mg/day methylprednisolone, which was thought to be acute adrenal insufficiency biochemically and clinically, and since hyperkalemia persisted, 0.05 mg/day fludrocortisone was added to the treatment. It was learned that the patient had been examined for abdominal pain for 6 months, and 15 mm nodular lesions were observed in both adrenal glands in the abdominal CT, but no further examination was performed. In adrenal CT, lesions measuring 41x30 mm on the right and 30x22 mm on the left at the body-medial crus level were observed in both adrenal glands, with a density higher than expected for adenoma (Figure 1). The findings were evaluated as significant in favor of nonadenomatous lesions, and due to progression in lesion sizes and high suspicion of malignancy, pheochromocytoma was excluded by checking urine catecholamines from the lesion in the right adrenal gland, and a tru-cut biopsy was performed. As a result of the pathology, the patient was diagnosed with high-grade B-cell neoplasia and hematological treatment was started. Conclusion Extranodal lymphoma involvement has been described with multiple different presentations in every tissue of the body, even within an organ system. Therefore, it should be included in the differential diagnosis of mass lesions. Tissue biopsy and immunohistochemistry are the most important methods for determining the specific subtype and cell origin.Figure 1:CT images of patientLesions in bilateral adrenal glands Table 1:Laboratory workup*Thyroid Stimulating Hormone. Table 2:Laboratory workup*Blood Urea Nitrogen,C-reactive Protein, Adrenocorticotropic hormone, Thyroid Stimulating Hormone

Risk of Cancers According to the Use of Biological Agents in Patients With Radiographic Axial Spondyloarthritis: A Nationwide Population-Based Cohort Study.

As the duration of use of biological disease-modifying antirheumatic drugs (bDMARDs) in patients with radiographic axial spondyloarthritis (r-axSpA) accumulates over time, long-term real-world safety data on cancer risk are needed. This study assessed the association between tumor necrosis factor inhibitors (TNFis) and interleukin 17 inhibitors (IL-17is) exposures and cancer risk in patients with r-axSpA. From the Korean nationwide database, we assembled 41,889 patients without prior history of cancer who were diagnosed with r-axSpA from 2010 onwards. Patients were followed up through 2021. Multivariable time-varying Cox models were performed to estimate the adjusted hazards ratios (aHRs) and 95% confidence intervals (CIs) of (1) overall cancers and (2) cancer subtypes according to TNFis exposure versus bDMARDs nonexposure, IL-17is exposure versus bDMARDs nonexposure, and IL-17is exposure versus TNFis exposure. The incident rates of overall cancers during bDMARDs nonexposure, TNFis exposure, and IL-17is exposure were 53.8, 37.6, and 67.3 per 10,000 person-years, respectively. TNFis exposure versus bDMARDs nonexposure was not associated with an increased risk of overall cancers (aHR = 0.9, 95% CI = 0.8-1.1). IL-17is exposure was not associated with an increased risk of overall cancers compared with bDMARDs nonexposure (aHR = 1.2, 95% CI = 0.5-3.0) or TNFis exposure (aHR = 1.3, 95% CI = 0.6-3.3). Similarly, no significant associations were observed between bDMARDs exposures and the risk of cancer subtypes. In patients with r-axSpA, there was no evidence of increased cancer risk with TNFis and IL-17is exposures compared with bDMARDs nonexposure, suggesting that the use of bDMARDs is safe with respect to cancer risk in patients with r-axSpA.

Assessment of the Efficacy and Safety of a Dual-Wavelength Diode Laser System for the Treatment of Vulvovaginal Atrophy in Women Without a History of Breast Cancer and in Patients with a History of Breast Cancer

Background/Objectives: Vaginal laser therapy is a promising treatment for menopausal vulvovaginal atrophy (VVA). This study evaluates the efficacy of a dual-wavelength diode laser (980 + 1470 nm) in treating VVA. Methods: Thirty postmenopausal patients with moderate-to-severe VVA were recruited, and twenty-nine completed the study. Patients underwent a screening visit (T0); three laser sessions at 4-week intervals (T1, T2, and T3); and a follow-up visit 4 weeks after the last treatment (T4). At T0 and T4, the Schiller test and Vaginal Maturation Index (VMI) were performed; sexual function was assessed through the Female Sexual Function Index (FSFI) and the Female Sexual Distress Scale-Revised (FSDS-R). At each visit, the Vaginal Health Index (VHI) and the Visual Analog Scale (VAS) for dyspareunia were administered. Potential side effects were investigated, and the VAS for the pain associated with the procedure was assessed. Data analysis included the overall group and two subgroups: women with (group A) and without (group B) a history of breast cancer (BC). Results: Significant improvements in the VHI and reduced dyspareunia were observed at T4 compared to T0 in all groups. The improvement was already seen after the first procedure, with further improvement after the other procedures, being persistent at the 1-month follow-up. The Schiller test showed significant improvements from T0 to T4 in all groups. The VMI showed a significant improvement from T0 to T4 in the overall group and group B. The FSFI questionnaires showed a significant improvement in all areas for the whole population, whereas the FDSF-R questionnaire showed an improvement only in the overall group. Procedural pain was low (mean VAS 1.6), and no side effects were reported. Conclusions: The dual-wavelength diode laser is an effective and safe option for the treatment of VVA in patients with and without a history of BC.

Sinonasal Mass in the Setting of Prior Maxillofacial Surgery and Solid Organ Malignancy

Fungal rhinosinusitis (FRS) can be classified into invasive and non-invasive forms, with the fungal ball (FB) representing a common non-invasive type with generally favorable outcomes post-operatively. The clinical presentation of FB can vary and be non-specific, and it is important to consider a wide differential diagnosis for sinonasal masses, including malignancy. We present the case of a 74-year-old female presenting with a two-year history of nasal obstruction and drainage. She has a history of breast cancer and prior maxillomandibular surgery, and imaging showed a poorly defined mass in the right maxillary sinus with possible hemorrhagic and/or proteinaceous content. Rigid nasal endoscopy revealed a friable mass, and endoscopic sinus surgery findings were consistent with FB. This case exemplifies the need to consider a broad set of differential diagnoses when evaluating sinonasal masses, especially if the patient has a prior malignancy or maxillomandibular surgical history, including FB and metastases to the paranasal sinuses. Given the presence of non-specific symptoms, it is important to consider early imaging for patients with distorted anatomy and a history of malignancy. Endoscopic sinus surgery, with high success rates, is the gold-standard treatment for FB.

Personality traits of women with hereditary risk for breast/ovarian cancer versus obstetric history and cancer preventive behaviors

The aim of the study is to analyze the relationship between personality traits of women with hereditary predisposition to breast/ovarian cancer and their obstetric history and cancer-preventive behaviors. A total of 357 women, participants of ‘The National Program for Families With Genetic/Familial High Risk for Cancer’, were included in the study. The Neo Five-Factor Inventory (NEO-FFI) and a standardized original questionnaire designed for the purpose of the study were used. Breast ultrasound examination at a younger age was associated with Extraversion. Openness to Experience was linked with lower number of children, more frequent use of hormonal contraceptives, and younger age at first breast ultrasound examination. Women with higher Agreeableness scores were less likely to use contraceptives and underwent their first breast ultrasound later in life. Conscientiousness was associated with more frequent use of hormonal contraceptives and younger age at first breast ultrasound examination. Women at increased risk for developing breast/ovarian cancer who used hormonal contraceptives underwent breast ultrasound examinations earlier in life, while those who had breastfed their children chose to have their first mammogram earlier in life. Personality traits affect health-related behaviors and should be taken into account when designing theoretical models as well as interventions regarding health habits.

Evaluation of β-thalassemias in the premarital hemoglobinopathy screening program: A retrospective study

Objective: To retrospectively evaluate β-thalassemias in the premarital hemoglobinopathy screening program in primary care. Methods: The retrospective study was carried out in Bursa Uludag University Family Health Center in Turkey between 1-30 September 2023. In the study, the data of individuals who applied to the Family Health Center for premarital health examination within the four years between January 1, 2019, and December 31, 2022, were taken from the database and evaluated retrospectively. Family history of hemoglobinopathy, sociodemographic findings, existing diseases, allergies, cancer, and genetic disease conditions were obtained. Complete blood count, and high-performance liquid chromatography (HPLC) results were examined. P-values below 0.05 were considered statistically significant. Analyzes were made in the SPSS 25.0 program. Results: A total of 327 people, 171 men (52.3%) and 156 (47.7%) women, participated in the study. It was determined that the age of the individuals was 30.17±6.16. The average Mentzer index levels were found to be 12.95±4.56. Places of birth are Mediterranean with 8.3% and other regions with 91.7%. β-thalassemia type detected in family medicine was suspected with a rate of 1.5% and carrier with a rate of 0.6%. The rate of patients referred to a hematologist was found to be 2.1%. The rate of patients with a definitive diagnosis was determined as 1.8%. It was determined that β-thalassemia definitive diagnosis rates were higher in groups whose place of birth was the Mediterranean region, with a family history of thalassemia, with a diagnosis of cancer, and with a genetic, allergic, and chronic disease diagnosis (p=0.01). Conclusion: Although it is not located in the Mediterranean region, the high prevalence of β-thalassemia in our population and its relationship with diseases are important. We emphasize the importance of a premarital screening program for the diagnosis of β-thalassemia due to its increasing frequency and complications in the globalizing world. doi: https://doi.org/10.12669/pjms.41.2.10024 How to cite this: Goktas O. Evaluation of β-thalassemias in the premarital hemoglobinopathy screening program: A retrospective study. Pak J Med Sci. 2025;41(2):590-597. doi: https://doi.org/10.12669/pjms.41.2.10024 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Solitary Axillary Lymph Node Metastasis From Ovarian Cancer on 18F-FDG PET/CT.

Solitary axillary lymph node metastasis from ovarian cancer is rare. A 74-year-old woman who had undergone hysterectomy and bilateral salpingo-oophorectomy for ovarian cancer 2 years ago presented to our hospital with enlarged axillary lymph node. 18F-FDG PET/CT revealed left axillary lymphadenopathy with an SUVmax of 8.92. The postbiopsy pathology confirmed metastasis of poorly differentiated ovarian adenocarcinoma. This case highlights the need to consider ovarian cancer metastasis in cases of solitary axillary lymphadenopathy with intense FDG uptake, especially in patients with a recent history of ovarian cancer.

Construction of the cancer patients’ database based on the US National Health and Nutrition Examination Survey (NHANES) datasets for cancer epidemiology research

BackgroundThe US National Health and Nutrition Examination Survey (NHANES) dataset does not include a specific question or laboratory test to confirm a history of cancer diagnosis. However, if straightforward variables for cancer history are introduced, US NHANES could be effectively utilized in future cancer epidemiology studies. To address this gap, the authors developed a cancer patient database from the US NHANES datasets by employing multiple R programming codes.MethodsTo illustrate the practical application of this methodology to a real-world problem, the authors extracted the R codes applied in an academic paper published in another journal on January 30th, 2024 (https://doi.org/10.1016/j.heliyon.2024.e24337). This paper will focus on the construction of the database and analysis using R codes. Entire.ResultsIn the first example, the urine concentration of monocarboxynonyl phthalate, monocarboxyoctyl phthalate, mono-2-ethyl-5-carboxypentyl phthalate, and mono-2-hydroxy-iso-butyl phthalate (all ng/mL) were used as the independent variable, instead of the serum concentration of perfluorooctanoic acid (PFOA), perfluorooctane sulfonic acid (PFOS), perfluorohexane sulfonic acid (PFHxS), and perfluorononanoic acid (PFNA), respectively. In the second example, the serum concentration of 2,3,3’,4,4’-Pentachlorobiphenyl (PCB105), 2,3,4,4´,5-Pentachlorobiphenyl (PCB114), 2,3’,4,4’,5-Pentachlorobiphenyl (PCB118), and 2,2’,3,4,4’,5’- and 2,3,3’,4,4’,6-Hexachlorobiphenyl (PCB138) were used as the independent variable, instead of the serum concentration of PFOA, PFOS, PFHxS, and PFNA, respectively.DiscussionThis research offers a comprehensive set of R codes aimed at creating a single, user-friendly variable that encapsulates the history of each type of cancer while also considering the age at which the diagnosis was made. The US NHANES provides a wealth of critical data on environmental toxicant exposures. By employing these R codes, researchers can potentially discover numerous new associations between environmental toxicant exposures and cancer diagnoses. Ultimately, these codes could significantly advance the field of cancer epidemiology in relation to environmental toxicant exposure.