History Of Previous Neoplasia Research Articles

Clinical and epidemiologic characteristics of hospitalized oncological patients with hypercalcemia: alongitudinal, multicenter study.

There are few studies that have analyzed the characteristics of hypercalcemia in hospitalized oncological patients. Our objectives were to describe the clinical characteristics of hospitalized patients with paraneoplastic hypercalcemia and to identify prognostic variables for mortality. This was an observational, longitudinal, retrospective, and bicentric study. It included adult patients admitted to two hospitals in Málaga, Spain (2014-2018). The minimum follow-up period was 2years or until death. Atotal of 154 patients were included; the majority (71.4%) were admitted to the internal medicine department. The median follow-up was 3.5weeks (interquartile range [IQR] 1.1-11.5). The mean (standard deviation) age was 67.6 (12.3) years, with apredominance of males (58.4%). The median (IQR) serum calcium at admission was 13.2 (11.8-14.6) mg/dl. The most common neoplasms were pulmonary (27.3%), hematologic (23.4%), urological (13%), and breast (12.3%). Furthermore, 56.5% of cases had aknown history of neoplasia at the time of diagnosis. The parathyroid hormone (PTH) level was determined in 24%; of these, 10.8% had elevated levels. In all, 95.5% of patients died during follow-up. The median survival was 3.4weeks (95% confidence interval 2.6-4.3). Factors associated with higher mortality were age, serum calcium at admission, previous history of neoplasia, etiology other than multiple myeloma, and noncorrection of hypercalcemia. In hospitalized patients, paraneoplastic hypercalcemia was associated with high short-term mortality. Several factors associated with aworse prognosis were identified in these patients.

P555 Switching from intravenous vedolizumab to subcutaneous maintains clinical remission even in intensified patients with Inflammatory Bowel Disease. One year follow-up

Abstract Background Vedolizumab is a humanized monoclonal antibody. It is indicated for moderate to severe flare of Inflammatory Bowel Disease (IBD). Subcutaneous (SC) vedolizumab, is a major advantage for patients for home administration. This study aimed to analyze the percentage of clinical and biochemical remission at 52 weeks in all IBD patients on treatment with intravenous (IV) vedolizumab after switching to the SC one. Methods Single-center, descriptive, observational, and retrospective study. The study included all the IBD patients (19 patients) who were at the moment of inclusion with IV vedolizumab treatment in a tertiary hospital, who underwent a switch from IV vedolizumab to SC vedolizumab. In addition, the relationship between treatment with intensified IV vedolizumab and subsequent drug levels versus patients without intensification for 52 weeks. Results Ten patients (22.6%) were diagnosed with Ulcerative Colitis (UC) and 9 patients (47.3%) with Crohn´s disease (CD). The baseline characteristics of the 19 patients are described in Table 1. Reasons for starting IV vedolizumab: there was loss of response to a first anti-TNF in 10 patients (52.6%) and loss of response to two previous anti-TNFs was observed in 3 patients (15.7%). In 4 patients (21%) IV vedolizumab was started as the first line of treatment due to the increased risk of infections and a previous history of neoplasia. Finally, in 2 patients with CD (10.5%) it was started as prevention of recurrence. Up to a total of 8 patients (42.1%) were on an intensified IV vedolizumab before switching to SC vedolizumab. All 19 patients (100%) were in clinical remission and 15 patients (78.9 %) remained in biochemical remission prior to switching to SC vedolizumab. At the end of the follow-up (52 weeks) all of them achieved clinical remission and 17 patients (89.4%) achieved biochemical remission (Figure 1). Therefore, biochemical remission was achieved in 10% more patients after the switch. It was noted that biochemical remission was achieved in 87% of patients on the intensified regimen with IV vedolizumab versus 100% of patients on the non-intensified regimen. No statistically significant differences were obtained between patients who had been on intensified IV vedolizumab and those who had not. At one year of follow-up, SC vedolizumab was suspended in one patient due to muscle pain, and IV vedolizumab was restarted again. Conclusion Following the standard dose switch of SC vedolizumab, clinical remission is maintained, achieving biochemical remission in 89.4 % of patients one year with SC vedolizumab with maintained vedolizumab levels, even in previously intensified IV vedolizumab patients.

Diagnostic Accuracy and Safety of Endoscopic Ultrasound-Guided End-cutting Fine-needle Biopsy needles for tissue sampling of Abdominal and Mediastinal Lymphadenopathies: a prospective multicenter series.

The role of the newer EUS-fine needle biopsy (FNB) needles in lymphadenopathies (LA) is still under evaluation. We aimed to evaluate the diagnostic accuracy and the adverse event rate of EUS-FNB in diagnosing LA. From June 2015 to 2022, all patients referred to 4 institutions for EUS-FNB of mediastinal and abdominal LA were enrolled. 22G Franseen tip or 25G Fork tip needles were used. The gold standard for positive results was surgery or imaging and clinical evolution over a follow-up of at least one year. A total of 100 consecutive patients were enrolled, consisting of those with a new diagnosis of LA (40%), presence of LA with a previous history of neoplasia (51%), or suspected lymphoproliferative disease (9%). EUS-FNB was technically feasible in all LA patients with 2 to 3 passes (mean 2.62±0.93). The overall EUS-FNB sensitivity, positive predictive value (PPV), specificity, negative predictive value (NPV), and accuracy were 96.20%, 100%, 100%, 87.50%, and 97.00%, respectively. Histological analysis was feasible in 89% of cases. Cytological evaluation was performed in 67% of specimens. There was no statistical difference between the accuracy of the 22G or 25G needle (p=0.63). A sub-analysis on lymphoproliferative disease revealed a sensitivity and accuracy of 89.29% and 90.0%. No complications were recorded. EUS-FNB with new end-cutting needles is a valuable and safe method to diagnose LA. The high quality of histological cores and the good amount of tissue allowed a complete immunohistochemical analysis of metastatic LA and precise subtyping of the lymphomas.

Carcinoma with Vertebral Column Metastasis in Two Dogs

Background: Carcinomas are aggressive and invasive malignancies that originate from any type of epithelial cell and are responsible for many deaths in dogs. Carcinoma metastases occur primarily via the lymphatic route; however, they can occur by blood flow, thus reaching bone structures. In dogs, metastasis of mammary and squamous cell carcinomas to the skeletal system is poorly described. The aim of this study was to report two cases of dogs that developed metastases of carcinomas to the vertebral column.Cases: Case 1. A 10 years-old, male, mixed-breed dog with paralysis of the left pelvic limb, subcutaneous mass in the lumbar region, apathy, anorexia and progressive weight loss and with a previous history of amputation of the right pelvic limb resulting from squamous cell carcinoma (SCC) in the integument of the cranial face of the femorotibiopatellar joint. Due to the patient's clinical condition and the negative prognosis associated with the neoplasia, euthanasia was performed. At necropsy, infiltrating the lumbar vertebrae from L5 to L7, a whitish and firm mass of approximately 15 x 8 cm was observed. Histologically, it comprised a malignant epithelial neoplastic development consisting of nests and cords interspersed with fibrovascular stroma, containing multiple keratine pearls. There was moderate to severe anisocytosis, severe anisokariosis, and about 4 mitosis figures for every 10 high power fields (400x). The histological features were consistent with an invasive SCC. Anti-cytokeratin and anti-p63 immunohistochemical (IHC) evaluations were performed, both with immunoreactivity in neoplastic cells. Case 2. An 8 years-old, female, Chihuahua with bilateral paralysis of the pelvic limbs, anorexia, and progressive weight loss, with a history of excision of solid mammary carcinoma. The clinical condition evolved to the absence of deep pain in all limbs and fecal and urinary retention, opting for euthanasia. At necropsy, a nodule between T3 and T4 was observed, yellowish-white and firm, measuring about 5 x 3.8 cm, invading the spinal canal, and compressing the spinal cord. Histologically, it comprised malignant epithelial neoplasia infiltrating intervertebral ligaments, musculature, and vertebrae of the thoracic spine, organized in a dense mantle of polygonal to rounded cells, delimited in lobes by abundant fibrovascular tissue. Moderate anisokaryosis and accentuated anisocytosis were observed and about 6 mitosis figures for every 10 high power fields (400x). The histological characteristics of the tumor were compatible with metastasis due to grade II solid mammary carcinoma. Immunohistochemical evaluations of anti-cytokeratin, anti-c-erbB2, and anti-estrogen and progesterone receptors were performed, with immunoreactivity for cytokeratin and c-erbB2 in neoplastic cells.Discussion: There are no current data indicating which tumors that metastasize most frequently to the vertebral column. In the reported cases, it was found that the clinical signs presented by the animals are directly associated with the compression of specific areas of the spinal cord, as well as bone pain, resulting from tumor expansion and degeneration of the bone matrix, similar to what has been reported previously. The immunohistochemical diagnosis of anti-p63 in case 1 and anti-oncoprotein C-erbB2 in case 2, were essential to determine the neoplastic origin in the absence of the primary tumor. Despite being a place of low incidence of metastases, bones have a physiologically favorable environment for the implantation of neoplastic cells, especially when there is bone marrow involvement. Because of this and despite the rare occurrence, metastasis of carcinomas to the vertebral column should always be considered as differential diagnoses in patients presenting with clinical signs compatible with spinal cord compression and a history of previous neoplasia.

PF339 BIOLOGICAL AND CLINICAL FACTORS THAT FAVOR THE USE OF A SPECIFIC TPO‐RA IN ITP PATIENTS. RESULTS FROM A SPANISH MULTICENTER STUDY

Background:To date there are no head‐to‐head randomized controlled trials comparing romiplostim (ROM) with eltrombopag (ELT) for the management of patients with primary immune thrombocytopenia (ITP). Having different routes of administration, which is the best choice of a thrombopoietin receptor agonist (TPO‐RA) for an individual patient is not clear.Aims:To analyze biological and clinical factors leading physicians and/or patients to the use of a particular TPO‐RA.Methods:We collected retrospectively the clinical data of 146 adult primary ITP patients who had initiated treatment with ROM or ELT between January 2012 and December 2014. Data on patient characteristics were collected from medical records in a multicenter study from 19 secondary and tertiary Spanish hospitals.Results:A minority of patients (n = 25) started TPO‐RA as short‐term therapy with an intention to treat of <2 months (14 ROM, 11 ELT). The most frequent single indication for a transient use of TPO‐RA was to increase platelet counts before a scheduled surgery; all patients (n = 6) received ROM in this scenario. No differences were observed between ROM and ELT in terms of sex, baseline platelet counts, time to achieve platelets >50x109/l, nor maximal platelet counts after short‐time TPO‐RA treatment. The majority of patients (n = 121, median age 63 years; range 19–96 years; 58.7% female) initiated TPO‐RA as long term treatment (ROM 54; ELT 67). Sixty‐eight percent of the patients met criteria for chronic, 16% for newly diagnosed and 16% for persistent ITP. There was a trend towards a preferential use of ELT in patients ≥65years (52.2% vs. 35.2% for ROM, P = 0.061). Neither gender, liver disease, history of previous neoplasia or vascular events, phase of the disease, or responses to earlier lines of therapy associated with the choice of TPO‐RA. We assessed the bleeding severity both at diagnosis and before initiation of TPO‐RA therapy according to the Page score (Br J Haematol. 2007;138:245–8). In univariate analysis, ROM was preferentially given to patients presenting with bleeding symptoms at diagnosis (66.7% of those receiving ROM) compared to 41.8% of bleeders among those receiving ELT (P = 0.006). The cumulative bleeding scale at diagnosis was also higher in those patients elected for treatment with ROM than ELT (median bleeding score at diagnosis 2 vs. 0, p = 0.003). At the time when TPO‐RA was initiated, the risk of hemorrhage (platelet counts 18x109/l vs. 25 x109/l for ROM and ELT, respectively; P = 0.014), and bleeding manifestations (bleeding score of 1 and 0 for ROM and ELT, respectively; P = 0.037) were also correlated with the selection of TPO‐RA. Additionally, six months before the start of TPO‐RA, the requirement for hospital care (emergency treatment or hospital admission) was higher in patients that were subsequently treated with ROM than those elected for ELT (55.6% vs. 31.8%, P = 0.009). In multivariate analysis with logistic regression, platelet counts before TPO‐RA and the need for hospital care 6 months before TPO‐RA correlated with the selection of TPO‐RA (Table 1).Summary/Conclusion:Our study shows a trend towards the use of ELT in older patients, but no influence of other patient characteristics, or previous therapies on the choice of TPO‐RA. While previous indirect data comparing ROM and ELT suggest that there is no substantial difference in the efficacy of these agents, real world data from this analysis indicates that the risk and severity of bleeding before starting TPO‐RA influences the selection of TPO‐RA in the clinical practice.image

Late recurrent cutaneous breast angiosarcoma in an elderly woman: A case report.

Breast angiosarcomas are malignant tumours of the vascular endothelium that arise frequently following radiation therapy. Their clinical and radiological aspects are highly heterogeneous. The current study reports an unusual case, never previously reported, of a late recurrent breast angiosarcoma occurring in an 83-year old female patient 11 years after a breast-conserving surgery followed by radiation therapy for an invasive ductal carcinoma, and 5 years after her initial angiosarcoma excision. The first physician to examine the patient noted a palpable mass near the scar and, following ultrasonography, described the breast lesion as suggestive of an abscess, despite the previous history of neoplasia. Typically, recurrences of breast angiosarcoma occur within the first postsurgical year. The present patient remains alive at 25 months after her last surgical treatment, and no evidence of any local or distant disease is observable.

Alveolar Rhabdomyosarcoma of the Paranasal Cavity in an Adult Woman

Alveolar rhabdomyosarcoma (RMS) is extremely rare in adults older than 45 years and may be very difficult to distinguish from other primitive round cell neoplasms without immunohistochemistry and/or genetic studies. In adults, the differential diagnosis of small round cell tumors of the head and neck region includes small cell carcinoma, lymphomas and neuroepithelial tumors, such as esthesioneuroblastoma and, as last choice, rhabdomyosarcoma. Initial immunoprofiling may not include myogenic markers. Moreover, aberrant expression of epithelial and neuroendocrine markers in alveolar RMS may be a potentially serious diagnostic pitfall. In this report, we describe the clinico-pathological features of a case of paranasal alveolar RMS in a 61-year-old woman with no previous history of neoplasia and discuss the differential diagnosis of small round cell tumor in the nasal/paranasal cavity. J Med Cases. 2014;5(1):26-30 doi: http://dx.doi.org/10.4021/jmc1498e

Anaplastic astrocytoma masquerading as hemorrhagic stroke

Although primary and metastatic brain tumors can cause intracranial hemorrhage, thalamic hemorrhage as the first presentation of an anaplastic astrocytoma has not been reported. We report a 47-year-old man who first presented with hypertensive hemorrhagic stroke. He improved with aggressive blood pressure control and recovered with minimal residual deficit within 10days. This led to the initial misdiagnosis of uncontrolled hypertension as the cause of the stroke. He deteriorated rapidly 4months later. A biopsy revealed an anaplastic astrocytoma. Misdiagnosis of tumor as stroke can occur in patients with vascular risk factors who do not have a previous history of neoplasia. Our case report is to heighten the awareness of the incidence of tumor apoplexy masquerading as stroke.

Metaplasia escamosa vesical, a propósito de un caso: Revisión de la literatura

We report a new case of squamous metaplasia because of its interest and subtle differential diagnosis with other bladder pathologies.We report the case of a male patient with history of previous neoplasia with an exophytic lesion of the bladder wall discovered on follow-up. Pathological diagnosis after TUR was bladder squamous metaplasia.Follow-up is performed by ultrasound, cystoscopy, and urine cytology in adherence to clinical guidelines due to the possibility of transformation into squamous cell carcinoma.Urothelium is able to develop non neoplastic transformations such as squamous metaplasia. The importance of such transformations depends on proper diagnosis and follow-up due to their ability to transform into a neoplastic process.

Vitamin and calcium supplement use is associated with decreased adenoma recurrence in patients with a previous history of neoplasia.

Although some have suggested that certain vitamins or calcium supplements may reduce adenoma recurrence, our own prior retrospective study found no such effects. The purpose of this case-control study was to further investigate whether regular vitamin or calcium supplement intake influenced the incidence of recurrent adenomatous polyps in patients with previous neoplasia who were undergoing follow-up colonoscopy. This study enrolled 1,162 patients who underwent colonoscopy by one of three surgeons at Columbia-Presbyterian Medical Center in New York City between March 1993 and February 1997. Of these patients 448 (250 males) had a previous diagnosis of colorectal neoplasia (cancer, adenomas, or dysplasia). Of these, 183 (40.8 percent) had an adenoma at the index colonoscopy. Information was collected on personal and family history of colonic diseases, cigarette smoking, medication, and vitamin and micronutrient supplement usage on a questionnaire that was completed by the patients before the colonoscopy. Odds ratios were obtained by unconditional logistic regression analysis, adjusting for age and gender, and used adenoma recurrence at index colonoscopy as the outcome. The mean interval between colonoscopic examinations was 37 months for the recurrent adenoma group and 38 months for the nonrecurrent group of patients (P = not significant). In this case-control study we found a protective effect for the use of vitamin supplements in general (any vitamin) on the recurrence of adenomas (odds ratio, 0.41; 95 percent confidence interval, 0.27-0.61). Specifically, this protective effect was observed for the use of multivitamins (odds ratio, 0.47; 95 percent confidence interval, 0.31-0.72), vitamin E (odds ratio, 0.62; 95 percent confidence interval, 0.39-0.98), and for calcium supplementation (odds ratio, 0.51; 95 percent confidence interval, 0.27-0.96). Nonsignificant protective effects were noted for carotene/vitamin A, vitamin D, and vitamin C. The use of multivitamins, vitamin E, and calcium supplements were found to be associated with a lower incidence of recurrent adenomas in a population of patients with history of previous colonic neoplasia. Prospective, randomized trials are needed to better assess the impact of these agents and to determine whether the use of these supplements is associated with a protective effect against recurrent adenomas.