Manifestation Of Malignancy Research Articles

Tumor Microenvironment and Dermatological Conditions in Prostate Cancer

Tumor initiation, progression, and invasion are closely related to the tumor microenvironment. Inflammation can modulate the activity of the cells in the TME and contribute to all stages of tumor development. The etiopathogenesis of cutaneous manifestations associated with prostate cancer is unclear. The cutaneous phenotype associated with prostate cancer could be supported by intratumoral heterogeneity, the remodeling of interactions in the tumor microenvironment, and the dynamics of the epithelial–mesenchymal transition. Among the urinary system cancers, prostate cancer presents few cutaneous signs and symptoms, most being diagnosed in the advanced stages of the disease. In this review, we analyze the cutaneous events associated with prostate cancer, represented by direct or indirect manifestations of the primary malignancy and the skin toxicities caused by oncological medications.

Imaging in malignant peritoneal neoplasms.

Peritoneal malignancies encompass a diverse range of tumors originating within the peritoneum, including primary tumors such as mesothelioma and primary serous peritoneal carcinoma or secondary tumors resulting from the spread of cancers from gastrointestinal, gynecological, and extra-abdominal sources. The traditional approach of palliative care for these malignancies is being replaced by a multimodal strategies that integrates surgery with systemic or intraperitoneal chemotherapy. Notably, cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy has shown significant improvements in survival rates. Imaging is crucial in the multidisciplinary management of these tumors, aiding in diagnosis, staging, restaging, and monitoring therapy response. It is also vital for appropriate patient selection, using the acronym "PAUSE", which involves assessing tumor burden via the peritoneal carcinomatosis index, evaluating patients pre- and post-therapy, detecting complications following therapy, and predicting treatment outcomes. This review explores the imaging manifestations of peritoneal malignancies, distinguishing them from various mimics, and underscores the importance of imaging modalities such as CT, MRI, PET/CT, and PET/MRI in effective decision-making and management.

8365 Bilateral Adrenal Hemorrhage Unveiling Adrenal Metastases In A Patient With Retroperitoneal Sarcoma

Abstract Disclosure: R.J. Shah: None. A.C. Goldberg: None. S. Jasim: None. Introduction: Metastatic disease to the adrenal gland is the most commonly occurring malignancy of the adrenal glands. Adrenal hemorrhage (AH) however is a rare but potentially fatal manifestation of malignancy. This case report highlights the unusual presentation of retroperitoneal sarcoma, manifesting as bilateral adrenal hemorrhage in the context of underlying metastases. Case Presentation: A 53-year-old man presented with a 4-week history of fatigue, intermittent abdominal pain radiating to the back, and vomiting. CT revealed bilateral adrenal masses measuring up to 8.5cm on the left side, with Hounsfield units (HU) 27, and 5.9cm on the right, HU 27, consistent with large areas of bilateral adrenal hemorrhage later confirmed on MRI. Biochemical evaluation included ACTH-stimulated cortisol, which was borderline at 17.4mcg/dl (recommended above 18-20mcg/dl), with a significantly elevated ACTH level of 103.8pg/nl (reference range 7.0-63.0pg/ml). Plasma metanephrines, electrolytes, aldosterone, and DHEA-S were normal. Although hemodynamically stable, he was started on prednisone 5mg daily as he was at high risk for primary adrenal insufficiency (AI). He was referred to endocrine surgery and further workup with PET/CT demonstrated a new FDG-avid periaortic retroperitoneal mass, with an interval increase in the size of the adrenal masses and development of hypoattenuating lesions in the kidneys and pancreas favoring aggressive metastatic disease. He underwent biopsy of the retroperitoneal mass, and pathology was consistent with high-grade sarcoma. Oncology started treatment with dexrazoxane and doxorubicin. His adrenal masses remained unchanged in size, and the patient died related to rapid progression of disease. Discussion: Spontaneous bilateral adrenal hemorrhage is rare with a reported incidence of 0.14 to 1.8%. Although most cases have been associated with sepsis, anticoagulation, hematologic disorders and trauma, it is important to maintain a high level of suspicion for underlying adrenal tumors and metastatic disease. AH can be a diagnostic challenge because of its non-specific presentation, and imaging is vital for timely recognition. Patients with bilateral AH should be managed with corticosteroids to avert AI-related fatalities. Presentation: 6/1/2024

A Rare Case of Pulmonary Tuberculosis Masquerading as Laryngeal Tuberculosis or Malignant Manifestation

Introduction: Laryngeal tuberculosis (LTB) is usually accompanied by pulmonary tuberculosis (TB) involvement. Misdiagnosis often occurs because the symptoms are non-specific and resemble laryngeal malignancy. We reported a rare condition of pulmonary TB masquerading as larynx abnormalities such as malignant manifestations. Case: A 59-year-old man presented with a main complaint of prolonged hoarseness without clinical respiratory complaints. The patient additionally reported coughing as a symptom while receiving medical treatment in the hospital. A computed tomography (CT) scan of the neck without contrast revealed a glottic tumor invading the vocal cord – T3N2cMx. Laryngoscopy examination revealed T1-T1 tonsils. The pharyngeal mucosa was slightly hyperemic. The arytenoids and epiglottis were less hyperemic. There was no edema, the left vocal fold was paralyzed, could not be adducted, and there was a lump. The glottis rima gap was narrow, size 3–4 mm, and the mass could not be evaluated. Chest X-ray examination was normal, but rapid molecular tests of TB detected very low Mycobacterium tuberculosis (MTB) levels. The patient was treated with anti-TB treatment (ATT) according to body weight. An evaluation was performed after 2 weeks, and the patient's clinical and physical condition improved. Conclusion: Pulmonary TB patients in endemic countries can have clinical manifestations such as LTB or laryngeal malignancy in 1% of cases. The prognosis for LTB with pulmonary T involvement is quite good with ATT administration.

The Cellular Stress and Cutaneous Manifestations in Renal Cell Carcinomas-A Narrative Review.

The carcinomas originating from the renal cortex are the most aggressive renal malignancies, with a high tendency for metastasis. Understanding the incidence of cutaneous manifestations caused by renal carcinomas is a challenge. In the first part, this article summarizes a series of factors that promote oncogenesis, invasiveness, and the ability of renal cell carcinoma (RCC) to develop secondary cutaneous manifestations. It is postulated that the cellular stress response is one of the leading causes of developing dermatological events induced by cancers located at distant sites. Furthermore, the paper provides an overview of cutaneous complications associated with renal cancer, categorized as malignant manifestations (metastases, synchronous or metachronous cutaneous malignancies associated with renal cancer), non-malignant indirect cutaneous manifestations associated with renal cancer, and treatment consequences. The data presented in this article suggest that recognizing certain cutaneous disorders could assist the physician in the early identification of renal neoplasms and could lead to a better prognosis.

LMIC-21. SERIES OF 9 CASES OF SPINAL CORD COMPRESSION IN CHILDREN: A SINGLE EXPERIENCE FROM THE PEDIATRIC NEURO-ONCOLOGY GROUP, IN A MIDDLE INCOME COUNTRIES

Abstract BACKGROUND Spinal cord compression secondary to pediatric neoplasms is a rare but serious event that can result in irreversible neurological sequelae, with paralysis, sensory losses and sphincter dysfunction. This retrospective study aims to describe the main causes, treatments and outcomes of a series of cases of spinal cord compression in patients admitted to the Childhood Cancer Treatment Institute- ITACI, University of São Paulo, Brazil. METHODS Based on data collected from the pediatric neuro oncology group, we analyzed nine cases of spinal cord compression in patients under 18 years, admitted from 2020 to 2023. RESULTS In our case series, 7 of the 9 children were female, with an average age of 104 months, the youngest being 3 months. Of the cases described, 77.7% had extradural spinal cord compression. Ewing’s sarcoma was the main neoplasm associated with extradural compression, representing 44.4%. Neuroblastoma, giant cell tumor and B acute lymphoblastic leukemia accounted for 11.1% of cases each. Cases of intradural compression were represented by low-grade glioma with cervical compression and germ cell tumor from with thoracolumbar lesion. Spinal cord compression was the first manifestation of malignancy in 8 of the 9 patients, who presented loss of motricity and sensitivity. All patients were treated with corticosteroid, therapy due to its benefits in reducing vasogenic edema caused by spinal cord compression. Additionally, 8 patients underwent surgical spinal decompression. A patient with Ewing sarcoma received cytoreductive chemotherapy and achieved complete motor recovery. CONCLUSIONS Spinal cord compression is associated with serious neurological sequelae when not treated appropriately. However, neurological recovery is possible with early diagnosis and adequate decompression treatment. We increased the importance of specialized services with a pediatric neuro-oncology group, in which several professionals work together to provide individualized care, even in developing countries, as demonstrated by the patients treated at our institution.

Level of competence of rural physicians in primary health care in the diagnosis of malignant neoplasms of main localizations

Objective. To analize the level of rural PHC doctors` competence on the issues of diagnosis and routing patients with suspected cancer. Materials and methods. The study was conducted using a survey of medical workers involved in the diagnosis of malignant neoplasms of four main localizations (specialist doctors and paramedics of examination rooms) of the Central District Hospital of five rural municipal districts of the Magnitogorsk oncological cluster of Chelyabinsk region. 35 physicians took part in the study. Results. The results of the survey were quite negative: the minority of respondents are aware of the exact duration of the mandatory initial diagnostic examination, the period of informing the oncologist about the patient diagnosed with cancer, and the scheme for assigning municipal medical organizations to outpatient oncology centers. Conclusions. The surveyed contingent is characterized by: low oncological alertness and unsatisfactory competence concerning the initial manifestations of malignancies; inclusion of symptoms of the formed cancer in the number of early manifestations of malignancies, which means that a doctor, unsure of the diagnosis, as if waiting for the appearance of an obvious, from his point of view, symptom of a tumor, and as a result, the patient has an advanced stage of cancer; 3) flawed ideas about the full list of necessary methods for diagnosing malignant neoplasms of leading localizations; unsatisfactory knowledge of regulatory documentation on the routing of patients with suspected cancer.

Interventional Treatment of Malignant Biliary Obstruction: Is It Time to Change the Paradigm?

Introduction. Biliary obstruction is a common manifestation of biliopancreatic malignancies, and its relief is an essential part of the treatment algorithm. Currently, there are three techniques to manage malignant biliary obstruction—endoscopic retrograde cholangiopancreatography (ERCP), percutaneous transhepatic biliary drainage (PTBD), and endoscopic ultrasound-guided biliary drainage (EUS-BD). ERCP has been adopted as a first-line treatment modality but EUS-BD is gradually emerging as a viable alternative. The aim of the current article is to assess the clinical outcomes of the three nonsurgical biliary drainage procedures. Materials and methods. A total of 102 consecutive patients with unresectable biliopancreatic malignancy inducing biliary obstruction and subjected to palliative treatment by means of ERCP, EUS-BD, or PTBD were retrospectively included in the study. Results. No difference in clinical and technical success of the procedures was found: ERCP—97.2% technical; 88.9% clinical; PTBD—94.4% technical, 72.2% clinical; EUS-BD—90% technical; 83.3% clinical. Adverse events (AEs) and reinterventions were significantly more common in PTBD (38.9% and 52.8%) and ERCP (27.9% and 25%) compared to EUS-BD (10% and 3.3%). Total duration of hospital stay and number of hospitalizations were lower in the EUS-BD compared to PTBD and ERCP groups. Conclusions. In the presence of adequate expertise, EUS-BD may be superior to PTBD and ERCP in achieving and sustaining biliary drainage in the setting of unresectable malignancy.

Surgical treatment of a massive soft tissue neurofibroma in neurofibromatosis type 1

Introduction. Neurofibromas developing in neurofibromatosis type 1 rarely grow to a large size. However, in cases of massive lesions, selection of optimal treatment tactics can be complicated. Clinicians usually resort to surgical treatment which currently serves as an effective instrument for improving patients’ quality of life and for achieving good cosmetic results.Aim. To describe a successful experience of surgical treatment in a patient with giant neurofibroma type 1 affecting a massive pool of soft tissues.Clinical case. Patient, 22 years, sought medical help at the N.N. Blokhin National Medical Research Center of Oncology with diagnosis of neurofibromatosis type 1 with massive lesions in the tissues of the lower third of the back, gluteal region, thighs. The disease has existed since birth, family medical history is fraught: father died of malignant manifestation of a neurogenic tumor. The younger sister is also diagnosed with neurofibromatosis affecting the brain and manifesting through cafe au lait spots on the body. Due to massive tumors significantly decreasing the patient’s quality of life, cytoreductive surgical treatment was prescribed aimed at maximally radical resection of all available tumors to alleviate the patient’s condition.Conclusion. The presented clinical case demonstrates successful experience of surgical treatment of a patient with giant neurofibroma affecting a massive pool of soft tissues.

Differential diagnosis of hematopoietic malignancies of head and neck: Report of six cases

Background: Lymphoma and multiple myeloma account for a small but significant proportion of all oral malignancies. Oral manifestations of hematopoietic malignancies are sometimes diagnosed with delay as most of them mimic various other diseases like osteomyelitis and periodontal diseases. We present five unusual, challenging cases of head and neck lymphomas and one case of oral myeloma. Methods: In this article, we report six cases, five cases of oral lymphomas, and one oral multiple myeloma case. All cases were initially diagnosed by oral histopathologists and then referred to specialists for further treatment. Results: We report these cases to understand these lesions better, as we saw some worrisome delays in their diagnoses. We aim to raise awareness about these hematopathological diseases among general dentists. Conclusion: It is crucial for the multidisciplinary team members to thoroughly examine the oral cavity for any worrisome lesions like these, as they might be an initial sign of a systemic disease. Pathologists must also be aware of the pitfalls in the interpretation of immunohistochemical sections and the immune profile of a tumor.

A tricky singular papular peri‐cicatricial mammarian lesion

AbstractBreast cancer represents the most common malignancy in women worldwide. In most cases, metastasis is the leading cause of mortality. Early diagnosis is still challenging despite standardised, government‐led screening programs, but is crucial in achieving improved survival rates. Additionally, a deeper understanding of the metastatic potential of breast cancer is critical for developing therapeutic interventions to combat widespread disease. Cutaneous metastasis from underlying breast carcinoma is uncommon as the first manifestation of visceral malignancies and is commonly observed in advanced‐stage malignancies, often associated with poor prognosis, and a prompt, precise tissue diagnosis is mandatory. A high index of suspicion in oncologic patients is required to diagnose these lesions, as they can mimic benign skin manifestations and clinical findings may be subtle and going unnoticed. We report on a case of a 76‐year‐old female patient presenting to our non‐invasive diagnostic outpatient clinic with an unusual cutaneous presentation, as an early sign of locally advanced invasive ductal carcinoma breast cancer recurrence. The aim of our article is to underline the importance of the dermatologist in the multi‐disciplinary oncologic diagnostic process, including non‐invasive imaging evaluation of cutaneous lesions, especially insidious breast carcinomas. Dynamic optical coherence tomography (D‐OCT) is not routinely used due to its cost, therefore lesion's aspect has not been completely described, consequently, the correct evaluation of skin architecture appearance can add important information, especially in cutaneous oncology where it can help in early diagnosis or cancer recurrency. OCT may contribute to the detection of subclinical cutaneous manifestations of cancer or recurrence, in particular, when they are difficult to differentiate clinically from benign lesion. In the case we described, OCT of suspected lesion showed the loss of the DEJ with solid nests and irregular vessels.

Fundamental insights and molecular interactions in pancreatic cancer: Pathways to therapeutic approaches

The gastrointestinal tract can be affected by a number of diseases that pancreatic cancer (PC) is a malignant manifestation of them. The prognosis of PC patients is unfavorable and because of their diagnosis at advanced stage, the treatment of this tumor is problematic. Owing to low survival rate, there is much interest towards understanding the molecular profile of PC in an attempt in developing more effective therapeutics. The conventional therapeutics for PC include surgery, chemotherapy and radiotherapy as well as emerging immunotherapy. However, PC is still incurable and more effort should be performed. The molecular landscape of PC is an underlying factor involved in increase in progression of tumor cells. In the presence review, the newest advances in understanding the molecular and biological events in PC are discussed. The dysregulation of molecular pathways including AMPK, MAPK, STAT3, Wnt/β-catenin and non-coding RNA transcripts has been suggested as a factor in development of tumorigenesis in PC. Moreover, cell death mechanisms such as apoptosis, autophagy, ferroptosis and necroptosis demonstrate abnormal levels. The EMT and glycolysis in PC cells enhance to ensure their metastasis and proliferation. Furthermore, such abnormal changes have been used to develop corresponding pharmacological and nanotechnological therapeutics for PC.

Paraneoplastic neurological syndrome associated with onconeural autoantibodies: report of two cases

Paraneoplastic neurological syndromes (PNS) are rare and often severe neurological complications of malignancies, significantly impacting patient prognosis and quality of life. They are characterized by a diverse range of onconeural autoantibodies, with further discoveries likely due to ongoing research. Among these, high-risk autoantibodies primarily target intracellular neural cell antigens. We present cases of lung cancer patients who developed limbic encephalitis and seizures at diagnosis, suggestive of PNS. Each case demonstrated distinct autoantibody profiles. Recognition of these potentially life-altering neurological sequelae, as paraneoplastic manifestations of malignancies, is crucial for physicians. PNS may precede primary cancer diagnosis and substantially affect patient presentation and overall outcome. We provide in detail the diagnostic work-up and available treatment options for these complex cases.

Paraneoplastic Syndrome: A Missed Diagnosis

AbstractParaneoplastic syndrome can involve a single organ or diverse organ systems. It is one of the rare manifestations of occult malignancy. A 47-year-old female patient with history of recent suspected herpes infection presented with features of extensive skin darkening and thickening, associated with poor swallowing and cough reflex. Patient was not able to lift both arms nor able to sit or stand which was suggestive of proximal muscle weakness involving the shoulders and hip. Patient's initial workup for autoimmune disorders including dermatomyositis was negative. With paraneoplastic syndrome as differential diagnosis contrast-enhanced computed tomography chest and abdomen and tumor markers CA125 and CA19.9 done showed no evidence of occult malignancy. Patient was started on empirical steroids for polyradiculoneuropathy. After starting steroids patients was able to sit and walk with support. Patient was able to swallow liquids without aspiration. On regular follow-up over a period of 3 months, patient developed abdomen pain and abdominal distention which on evaluation showed ascites and multiple new cystic ovarian lesions suggestive of ovarian malignancy. Patient's CA125 was repeated and was markedly elevated. Patient was referred to an oncologist and was started on chemotherapy along with immunosuppressants. This case report emphasizes the need for regular follow-up of patients suspected of paraneoplastic syndrome. Although the initial workup for malignancy did not give a clue, on periodic review we were able to make the primary diagnosis and start appropriate treatment and achieve a better patient survival.

Ophthalmic manifestations in hematological malignancies: An observational study from a tertiary care health center in Eastern India.

This study aimed to document the spectrum of ocular manifestations of hematological malignancies presenting to a tertiary health center in Eastern India and their association with blood parameters. This hospital-based cross-sectional study was conducted from August 2021 to July 2022. Patients diagnosed with leukemia, lymphoma, and multiple myeloma were enrolled in the study. A comprehensive ophthalmic evaluation was done in each case. A total of 97 patients with a confirmed diagnosis of hematological malignancies and meeting the inclusion and exclusion criteria were included in the study. Ocular manifestations were noted in 48 (49.48%) patients. Acute lymphocytic leukemia accounted for 35.4% of cases, followed by acute myeloid leukemia (31.25%), lymphoma (4.2%), and minimum manifestation in multiple myeloma (2.1%) patients. Among 48 patients with ocular manifestations, anterior segment involvement was found in 6.2% of cases, with subconjunctival hemorrhage being the most common, and the posterior segment was involved in 100% of patients, with intraretinal hemorrhages being the most common manifestation. A statistically significant association was noted between hemoglobin, total red blood cell count, and total platelet count with posterior segment manifestations ( p < 0.001). On multivariable logistic regression, only total leucocyte count and total platelet count were significant predictors for ocular manifestation. Indirect involvement of the retina is the most common ocular pathology in hematological malignancies, with intraretinal hemorrhages being the most common finding. Ophthalmic examination is highly recommended as a part of the routine evaluation at the time of diagnosis of hematological malignancies and periodically thereafter to diagnose any ocular involvement.

Neutrophilic and eosinophilic dermatoses associated with hematological malignancy.

Cutaneous manifestations of hematologic malignancy represent both a clinical challenge for the treating physician and a pathophysiological model for advancing the knowledge on individual neoplasms. Indeed, a growing body of evidence supports the concept of recurrent molecular defects associating with specific clinical features, as best exemplified by VEXAS. Herein neutrophilic and eosinophilic dermatoses of potential interest for both hematologists and dermatologists will be reviewed, including subcorneal pustular dermatosis-type IgA pemphigus, neutrophilic eccrine hidradenitis, Sweet's syndrome as well as myelodysplasia cutis and VEXAS, pyoderma gangrenosum, eosinophilic annular erythema, eosinophilic dermatosis of hematological malignancy, Wells syndrome and cutaneous involvement in hypereosinophilic syndromes. Possible management approaches are discussed for each, emphasizing scenarios that require treatment of the underlying condition to achieve remission at the skin level.

Squamous Cell Carcinoma Arising in Chronic Inflammatory Dermatoses.

Squamous cell carcinoma (SCC) is a known sequela of chronic inflammatory conditions of the skin. Labial discoid lupus erythema-tosus (DLE), oral lichen planus (OLP), and lichen sclerosus have a relatively short lag time from dermatosis onset to manifestation of malignancy; cutaneous DLE, hypertrophic lichen planus, chronic wounds, hidradenitis suppurativa (HS), and necrobiosis lipoidica can be present for decades before an associated malignancy is observed. Vigilant monitoring is essential for orolabial DLE, chronic HS, and chronic wounds because malignancies in these settings are particularly aggressive and often fatal. We summarize what is known about the nature and demographics of SCC arising within chronic inflammatory dermatoses, emphasizing lag time from dermatosis diagnosis to malignancy onset of common inflammatory conditions.

Inborn errors of immunity: A field without frontiers.

The study of primary immunodeficiencies or inborn errors of immunity continues to drive our knowledge of the function of the human immune system. From the outset, the study of inborn errors has focused on unraveling genetic etiologies and molecular mechanisms. Aided by the continuous growth in genetic diagnostics, the field has moved from the study of an infection dominated phenotype to embrace and unravel diverse manifestations of autoinflammation, autoimmunity, malignancy, and severe allergy in all medical disciplines. It has now moved from the study of ultrarare presentations to producing meaningful impact in conditions as diverse as inflammatory bowel disease, neurological conditions, and hematology. Beyond offering immunogenetic diagnosis, the study of underlying inborn errors of immunity in these conditions points to targeted treatment which can be lifesaving.

Immunomodulating response of autologous cryo-hematological treatment in patients with malignant manifestations

Immunomodulating response of autologous cryo-hematological treatment in patients with malignant manifestations

Pseudoprogression As Adverse Event of Chimeric Antigen Receptor T Cell Therapy

CAR-T-cell therapy (CARTCT) expands the range of therapeutic options for patients with hematologic malignancies. While complications such as cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS) are well known, pseudoprogression (PP) is until now mainly described after checkpoint inhibition. Some reports on CARTCT induced PP (CARTiPP) exist distinguishing it from progressive disease, while only few reports focus on acute local complications. Considering the paucity of data about CARTiPP, we aimed to assess patients treated in our center. We defined CARTiPP as initial volume increase of malignant manifestations within ten days of CARTCT followed by tumor regression without another genesis being more probable. Distinction from true progression of malignancy can be achieved either retrospectively or by histopathological findings. Here, we characterize a retrospective monocentric patient cohort with the occurrence of CARTiPP. Evaluation of clinical, laboratory, radiological, and/or histopathological data was carried out. A total of n=8 patients were identified with CARTiPP throughout a treatment period of 46 months with n=78 patients receiving CARTCT resulting in a frequency of 10%. These eight patients had different B cell Non-Hodgkin lymphoma (B-NHL) subtypes (n=7) or multiple myeloma (n=1, extramedullary involvement) and were treated with anti-CD19 or anti-BCMA CAR-T-cells after standard lymphodepletion (once fludarabine monotherapy). The median age of patients was 61 years (range 39-76 years). Routine staging before CARTCT assessed n=4 patients as in partial remission (PR), n=1 with stable disease (SD) and n=3 with progressive disease (PD). CARTiPP occurred at a median of 5 days (range 4-7 days) after CARTCT. CAR T-cell expansion measured via droplet digital polymerase chain reaction (ddPCR) peaked earlier than expected from literature data after an average of 8 days post-infusion (range 7-11 days) in patients experiencing PP with a median peak of 182 CAR T copies/µL (range 39-2812 copies/µL) at this time. We observed variable complications, e.g. superior vena cava syndrome, postrenal kidney injury and compartment syndrome. The analogy in clinical CARTiPP presentation with previous symptoms in stages of further advanced disease was striking in most patients (n=6). All events were rated as adverse events ≥ CTCAE II (Common Terminology Criteria of Adverse Events). CRS occurred parallely with PP in n=7, ICANS in n=3 patients. Complication management ranged accordingly from intensified monitoring to treatment with glucocorticoids/tocilizumab to limb amputation in one patient.There was no CARTiPP-associated mortality. In one of the affected cases intensive care treatment was required due to complications other than CARTiPP. CARTiPP may be still underreported. Frequency and in some cases severity underline the need for raising awareness of treating physicians. Laboratory analyses and imaging may supplement clinical assessment and should be further examined. The establishment of risk assessment, preventive measures and early detection to reduce therapy-induced morbidity as well as a systematic documentation analogous to CRS and ICANS might be required for CARTiPP. The increasing availability of corresponding CAR-T-cell therapies for a steadily expanding number of disease entities with variable manifestations and different disease stages makes an increasing frequency of CARTiPP plausible.