Stage IVA Squamous Cell Research Articles

Oncologic outcomes of pelvic exenteration for stage IVA cervical cancer: A rarely utilized treatment modality (528)

<b>Objectives:</b> To investigate the outcomes of pelvic exenteration for patients with FIGO stage IVA cervical carcinoma. <b>Methods:</b> Patients diagnosed between 2004 and 2015 with FIGO 2009 stage IVA squamous cell, adenocarcinoma, or adenosquamous cervical carcinoma with no history of another tumor were selected from the National Cancer Database. Patients who received definitive chemoradiation (defined as external beam radiation therapy of at least 45 Gy, with concurrent chemotherapy) with no other surgical procedure and those who underwent primary pelvic exenteration with negative surgical margins were identified. Clinical-pathologic and demographic characteristics were compared. Overall survival was compared following 1:1 propensity score matching for the year of diagnosis, patient age, comorbid conditions, patient race, and insurance status. <b>Results:</b> A total of 64 patients who underwent pelvic exenteration and had negative margins were identified. The comparison group included 1176 patients who had definitive chemoradiation and did not undergo any surgical procedure. There was no statistically significant difference between the two groups in terms of patient age, race, and presence of comorbid conditions. However, patients who underwent exenteration were more likely to have private insurance (59.4% vs 34.4%, p<0.001). For patients who underwent exenteration, the unplanned re-admission rate was 11.5%, while median hospital stay was 11.5 days and 90-day mortality was 3.3%. The majority also received radiation therapy (85.9%). Following propensity score matching, patients who underwent pelvic exenteration had better OS (5-yr OS rate: 48.1%, median OS: 43.96 months) compared to those who had chemoradiation (5-yr OS rate: 16.5%, median OS: 18.63 months). <b>Conclusions:</b> Pelvic exenteration is rarely utilized in the management of patients with stage IVA cervical cancer. For carefully selected patients, overall survival may be superior to primary chemoradiation.

Outcomes of Definitive Chemoradiotherapy for Stage IVa (T4b vs. N4) Esophageal Squamous Cell Carcinoma Based on the Japanese Classification System: A Retrospective Single-Center Study.

Simple SummaryDefinitive chemoradiotherapy is a standard treatment for stage IVa esophageal cancer, although it is unclear whether T/N factors affect treatment outcomes and whether we should modify chemoradiotherapy regimens based on T/N factors. This single-center retrospective study aimed to determine whether T/N factors affected progression patterns and overall survival after chemoradiotherapy for stage IVa esophageal squamous cell carcinoma. There were no significant differences between the T/N groups in terms of overall survival, progression-free survival, or progression patterns. Therefore, it may not be useful to modify chemoradiotherapy regimens based on T/N factors for patients with stage IVa squamous cell carcinoma.The differences in prognoses or progression patterns between T4b non-N4 and non-T4b N4 esophageal squamous cell carcinoma post chemoradiotherapy (CRT) is unclear. This study compared the outcomes of CRT for stage IVa esophageal squamous cell carcinoma according to T/N factors. We retrospectively identified 66 patients with stage IVa esophageal squamous cell carcinoma who underwent definitive CRT at our center between January 2009 and March 2013. The treatment outcomes, i.e., progression patterns, prognostic factors, and toxicities based on version 5.0 of the National Cancer Institute Common Terminology Criteria for Adverse Events, were studied. The patients (56 men and 10 women) had a median age of 67 (range: 37–87) years. The T/N classifications were T4b non-N4 (28/66), non-T4b N4 (24/66), and T4b N4 (14/66). Objective response was achieved in 57 patients (86.4%, (95% confidence interval, 74.6–94.1%)). There were no significant differences between the T/N groups in terms of overall survival, progression-free survival, and progression pattern. We found no significant differences in prognoses or progression patterns among patients with T4b non-N4, non-T4b N4, and T4b N4 esophageal squamous cell carcinoma. Thus, it seems impractical to modify CRT regimens based on T/N factors.

Bronchocutaneous fistula from metastatic cervical cancer with COVID-19

A 38-year-old woman with a history of stage IVA squamous cell cancer of the cervix presented with pain and an enlarging wound in her central chest. Approximately 20 months earlier...

Submental island flap reconstruction of large and complex oral commissure defects

Background Oral commissure squamous cell carcinoma frequently presents at advanced stage and surgical treatment will eventually result in large and complex lip, buccal, and facial skin defects. Reconstruction of such defects is a challenge. The authors hereby present the experience with the reconstruction of large and complex postexcisional defects of the oral commissure with submental island flap. Patients and methods Eighteen patients with stage IVA squamous cell carcinoma of the oral commissure were enrolled. For all patients wide surgical excision of the primary tumor with supraomohyoid neck dissection followed by immediate reconstruction of the resultant defect with submental island flap was done. During the follow-up period, surgical and oncologic outcomes were reported; and functional and aesthetic outcomes were evaluated using the Functional Lip Glasgow Scale score. Results Male predominates and the mean operative time was about 197 min. Surgical complications were unremarkable. Functional Lip Glasgow Scale score ranged from 18 to 25. Recurrence occurred in three cases. Conclusion Submental flap is a feasible reproducible reconstructive technique for oral commissure tumors surgery with satisfactory functional and aesthetic outcomes.

Expecting the unexpected.

e14066 Background: Myasthenia gravis is an autoimmune neuro-muscular disorder traditionally seen in bi-modal distribution in young women or older men. Discovery of immunotherapy has brought hope in survival outcomes for patients with malignant melanoma, lung, renal and head/neck cancers but it also opens Pandora’s box of immune-related toxicities for which early recognition and appropriate clinical management are paramount. Here we describe a case of immunotherapy induced myasthenia gravis de novo. Methods: A 77-year-old man with HPV+ stage IVA squamous cell carcinoma of the tongue presented with sudden onset orthopnea and dyspnea on exertion for the past day. One week ago, he received his second cycle of nivolumab as part of his neoadjuvant therapy. He was seen at an outside hospital and was found to be acute hypercapnic respiratory failure and placed on BiPAP. He was started on antibiotics for community-acquired pneumonia with levofloxacin and doxycycline and transferred to a tertiary care center for further management. On further evaluation, he endorsed diplopia, blurry vision, fluctuating muscle weakness that is worse at the end of the day, change in voice and proximal muscle weakness. His exam was consistent with bilateral ptosis, weak hip flexion and shoulder abduction, positive sniff test and poor vital capacity and negative inspiratory force values suggestive of impending respiratory and diaphragmatic failure secondary to myasthenic crisis. He was admitted to the ICU and placed on BiPAP and frequent NIF and VC monitoring. He was started on pyridostigmine but showed no clinical improvement on day 1 and hence was initiated on plasmapheresis from day 2 for a total of 10 days. Results: Investigations showed positivity of Ach-R modulating and binding and blocking antibodies with negative voltage gated calcium channel antibodies. EMG revealed decrement of the compound muscle action potential in the repetitive stimulation test indicative of myasthenia gravis. He responded well to the above treatment and underwent successful left partial glossectomy and weaned off mechanical ventilation and has been cancer free so far. He is doing well on maintenance prednisone and pyridostigmine. Conclusions: There is a significant 30.4% MG-specific-related mortality due to immunotherapy alone which this case demonstrates the importance of vigilance and early detection for effective treatment and management. It highlights need for the oncological world and our colleagues in various other disciplines of healthcare to identify and mitigate the effects of immunotherapy which has become our hope in beating cancer.

A Rare Case of Candida Brain Abscess Secondary to Metastatic Tongue Cancer on Initial Presentation

SESSION TITLE: Student/Resident Case Report Poster - Critical Care IV SESSION TYPE: Student/Resident Case Report Poster PRESENTED ON: Tuesday, October 25, 2016 at 01:30 PM - 02:30 PM INTRODUCTION: Fungal brain abscesses are rare causes for altered sensorium and they are often resistant to treatment, resulting in high morbidity and mortality. Brain abscesses are commonly caused due to fungal organisms, especially Candida species. CASE PRESENTATION: A 53 year old man with past medical history of diabetes presented to the emergency department after being found on the floor. The patient was alert and oriented only to place and person. Patient was diagnosed with diabetic ketoacidosis, acute kidney injury, acute pancreatitis for which he was appropriately treated. Computed tomography (CT) abdomen was consistent with left pyelonephritis and prostatic abscess. Initial urine, blood and stool cultures revealed Candida albicans. Intravenous micafungin and fluconazole were instituted based on culture reports. HIV test was negative. Magnetic resonance Imaging (MRI) of brain demonstrated ring enhancing lesions with vasogenic edema and abnormal restricted diffusion (Figure 1A & 1B). Lumbar puncture was noncontributory. Treatment was changed from micafungin to liposomal amphotericin B with fluconazole with which patient demonstrated both clinical and radiological improvement (Figure 2A &2B). Further evaluation showed an enhancing tongue mass with cervical lymphadenopathy. Biopsy proved the presence of Stage IVA squamous cell cancer of the tongue. Early neoplastic markers, Anti-Hu and Anti-Yo antibodies were negative. DISCUSSION: Candida cerebral abscess are mostly diagnosed at autopsy. An autopsy series demonstrated that up to 6% of patients with systemic candidiasis have evidence of undiagnosed CNS involvement as well. Risk factors include penetrating trauma, neurosurgical intervention, IV drug abuse, corticosteroid use, and malignancies. Candida brain abscesses can also be secondary to the infection of the adjacent structures or be secondary to hematogenous spread from endocarditis, intrabdominal or genitourinary tract infections as in our case. Risk factors present in our patient included diabetes mellitus and malignancy. Only 55% of blood cultures and 23% of lumbar puncture are positive for Candida1. CT and MRI are the preferred imaging modalities for diagnosing brain lesions and monitoring response to therapy. A definitive diagnosis can be achieved from stereotactic brain biopsy, although this is rarely reported. Infectious diseases society of America recommends liposomal Amphotericin B with flucytosine for several weeks to manage Candida brain abscess, switching to azole based therapy. CONCLUSIONS: This case demonstrates the need to consider fungal brain abscesses, as differentials for altered mental status and that with the aid of MRI and effective management, patients may improve neurologically as seen in this patient. Reference #1: Andrea M. Fennelly, Amy K. Slenker, Lara C. Murphy, Michael Moussouttas, Joseph A. Desimone. Candida cerebral abscesses: a case report and review of the literature. Med Mycol (2013) 51 (7): 779-784. DISCLOSURE: The following authors have nothing to disclose: Shyam Shankar, Sushilkumar Gupta, Ishan Malhotra, Mangalore Amith Shenoy, Hatem Desoky, Prarthna Chandar, William Pascal, Stephan Kamholz, Richard Periut, Chanaka Seneviratne, Yizhak Kupfer No Product/Research Disclosure Information

Radiation-Induced Spinal Glioblastoma Multiforme: A Rare Complication in the Management of Head and Neck Cancer

Background: Radiation-induced gliomas of the spinal cord are rare late complications of spinal cord irradiation that typically occur in patients treated at younger ages. Aim: Raise awareness of radiation induced high grade gliomas with a case presentation and a review of the literature. Case Presentation: A 50-year-old male with Stage IVA squamous cell carcinoma of the oropharynx was treated with external beam radiotherapy with a complete response. Seven years later, he presented with a cervical spinal cord mass on MRI. An open biopsy was performed. Pathology revealed an intramedullary WHO grade IV astrocytoma, (i.e., glioblastoma multiforme) of the cervical spine that fulfilled the criteria for a radiation-induced malignancy. Conclusions : Review of the literature suggests that radiation-induced gliomas tend to be high grade and may occur at the periphery of an irradiated field. Radiation-induced gliomas of the spinal cord are a serious complication of radiotherapy that may occur in older patients with head and neck cancers, but are so rare that it should not affect treatment decisions.

Recombinant Porcine Factor VIII, Obi-1, Successfully Controlled Gastrointestinal Bleeding in a Patient with Acquired Hemophilia A

▪Introduction: Acquired hemophilia A (AHA) is a rare, life-threatening bleeding diathesis categorized by low levels of Factor VIII (FVIII) due to an acquired auto-antibody against FVIII. Treatment for AHA requires both control of the bleeding and eradication of the inhibitor. Recombinant activated factor VII (rFVIIa) maybe used to control the bleeding, but with only mixed results in controlling gastrointestinal bleeding (GIB). rFVIIa is associated with thrombosis risk and lack of ability to monitor. The recombinant porcine FVIII (rpFVIII), OBI-1, recently obtained regulatory approval based on the results of Phase 2/3 trial, but the patients in this cohort did not have GIBs. Here we present a patient with AHA admitted with a GIB and successfully treated with OBI-1.Case: A 69 year old African American female with T1N0M0 infiltrative ductal carcinoma of the left breast and Stage IVA Squamous cell carcinoma of the cervix, treated in 1997 and 2007 respectively, presented to the emergency department with two days of painless bright red blood per rectum. She was orthostatic (supine: HR 79, BP 112/77 and standing: HR 111, BP 100/72) with hemoglobin (Hb) of 5.7gms/dl. An EGD demonstrated a bleeding vessel and multiple arteriovenous malformations (AVM) in the gastric body that were secured with clipping. Over the next 5 days EGD was repeated twice and multiple endoclips were placed in an attempt to achieve hemostasis. She subsequently underwent angiography to identify a target vessel for embolization, but one could not be found. On hospital day 11, hematology was consulted for a prolonged aPTT (113.8 seconds) and inadequate correction with mixing studies (63.7 seconds). FVIII level was <1% with factor VIII inhibitor titer of 245 Bethesda Units/ml (BU). Prior to starting OBI-1, she received 9 units of packed red blood cells and 2 units of fresh frozen plasma. OBI-1 was started at 200u/kg q4h for first 2 days and then decreased to q8h, with cessation of bleeding within 24 hours. Upon completion of the bolus of OBI-1, her FVIII level was 14%, then 38% at 8 hours, 48% at 16 hours and 62% at 24 hours. Rituximab (375mg/m2 weekly) and corticosteroids (prednisone 1mg/kg daily x7 days) were given in an attempt to eliminate the inhibitor. She remained stable for 6 days but subsequently developed abdominal pain. A CT of the abdomen revealed free air prompting emergent surgical intervention. She had internal hernia in the pelvis, ischemic small bowel and perforated jejunum requiring extensive resection. During this time she remained on rpFVIII (200u/kg q8h) with FVIII pre-infusion levels ranging from 2% - 14% and post-infusion levels from 80% to 217% and had only 25ml estimated blood loss during surgery. Unfortunately, 1 day after surgery she developed multi-organ failure and expired on hospital day 19.Discussion: OBI-1 is a glycosylated, B-domain deleted recombinant porcine factor VIII that retains the ability to interact with Factor IXa and activate Factor X, but it is less inhibited by auto-antibodies to human FVIII. For FVIII inhibitor titers >5 BU, an inhibitor bypassing agent is usually necessary because human FVIII products are not able to overcome the inhibitor. Given the high FVIII inhibitor titers in this patient, administration of rFVIIa or OBI-1 was necessary. Our own institutional experience of treating GIBs in patients with AHA had poor outcomes. The efficacy of rFVIIa in treating GIB is inconclusive, with response rate ranging from 53% to 71%. However, rFVIIa is associated with a risk of thrombosis approaching 9.4%, especially in older patients and those with vasculopathy, a common demographic in AHA. Unlike rFVIIa, OBI-1 allows close monitoring of FVIII and in the aforementioned Phase 2/3 trial, there were no thrombotic complications or serious adverse events. We were successful in controlling the bleeding within 24 hours with OBI-1 and were able to achieve therapeutic levels of FVIII despite high Bethesda titers. Unfortunately, our patient died from an ischemic bowel and perforated jejunum that was likely related to hernia or repeated instrumentation in an attempt to stop the bleeding prior to the diagnosis of AHA.Conclusion: OBI-1 appears to effectively and rapidly overcome a high titer FVIII inhibitor and control bleeding in a patient with AHA and GIB. While this is a promising therapy, additional study is necessary to determine safety, efficacy, and cost-effectiveness. DisclosuresNo relevant conflicts of interest to declare.

BM-12 * CEREBRAL INFARCTION SECONDARY TO PULMONARY VEIN COMPRESSION AND LEFT ATRIAL APPENDAGE TUMOR INFILTRATION AS THE PRESENTING SIGN OF METASTATIC SQUAMOUS CELL CARCINOMA OF THE BASE OF THE TONGUE

BACKGROUND: Squamous cell carcinoma of the tongue has been documented to metastasize to the lungs and rarely involve the heart. The majority of documented cases of cardiac metastases are from postmortem analysis. Cases of sudden death, syncope, and dyspnea have been reported. However, stroke and tumor embolization to the brain as the initial clinical presentation has not been documented in the English literature. METHODS: Case Report. RESULTS: This case addresses a 61-year-old male with Stage IVA squamous cell carcinoma of the left tongue base, believed to be in remission after systemic chemotherapy and local radiation, who presented with acute cerebral infarctions involving multiple vascular territories. Cardiac CT obtained during stroke etiology evaluation displayed metastatic disease compressing the pulmonary vein resulting in virtual pulmonary vein thrombus. Transthoracic echocardiogram was negative for cardiac valvular pathology. Anticoagulation was initiated. Twelve days later he returned with recurrent strokes and suspected tumor embolization to the brain. Imaging displayed left atrial appendage structural abnormality highly suggestive of tumor infiltration. CONCLUSION: Cardiac metastases are rare and non-myxomatous tumor embolization to the brain even rarer especially in the setting of cerebral infarction due to pulmonary vein thrombus. Here we describe a case of multiple acute cerebral infarctions appearing from a proximal source refractory to anticoagulation. Thromboembolism from the pulmonary vein and tumor embolization from cardiac metastases are the likely mechanisms for his clinical presentation and radiographic findings. This case demonstrates the complexity of multiple stroke etiologies in one patient and the importance of cardiac imaging in stroke evaluation, particularly in the setting of a patient with a history of cancer.

Outcomes for stage IVA squamous cell carcinoma of the oral cavity according to staging subtypes.

6076 Background: Patients with locoregionally advanced squamous cell carcinoma of the oral cavity (SCCOC), defined as stages III to IVB without T4b, are treated similarly and combined for enrollment into most clinical trials. There are several combinations of tumor (T) and lymph node (N) categories for stage IVA. We evaluated the differences in outcomes according to subtypes of patients with stage IVA SCCOC. Methods: The Surveillance, Epidemiology, and End Results (SEER) database was queried for patients with stage IVA SCCOC diagnosed between 1988 and 2007. Patients were subdivided according to tumor (T) and lymph node (N) status. Overall survival (OS) was estimated by the Kaplan-Meier method and compared by using log-rank test. Cox proportional hazard regression models were used for multivariate analyses. Results: Among the 3,904 patients meeting inclusion criteria, most patients underwent surgery, either alone (24%) or with radiation (59%). There was a significant difference in outcomes according to AJCC subsets (T4aN0, T4aN1, T1N2, T2N2, T3N2 and T4N2), with 5-year OS ranging from 15.8% in T4aN2 to 41.3% in T4aN0 (HR 2.3; 95% CI 2.03-2.62, p &lt; 0.001). Since the 5-year OS was similar for patients with T1N2-T2N2 and T3N2-T4aN2, these groups were further subdivided according to the T (T1-2 or T3-4a) and N2 subsets. The 5-year OS was significantly different according to the subgroups, ranging from 11.8% in T3-4aN2c to 37.5% in T1-2N2a (Table). The stage subgroups remained independent predictors for survival after adjusting for age, gender, race and treatment. Conclusions: Stage IVA SCCOC is a heterogeneous disease with significant differences in outcomes according to its subsets. If these findings are confirmed in additional studies, further subdivision of stage IVA may be warranted. [Table: see text]

Cetuximab in hemodialysis: A case report

Concurrent chemoradiotherapy with cisplatin is the standard therapy for patients with unresectable locally advanced head and neck squamous cell carcinoma. However, cisplatin administration in patients on hemodialysis is complicated by the need to perform hemodialysis immediately after the infusion. Concurrent chemoradiation with cetuximab has been approved in definitive treatment of locally advanced head and neck cancer. Although cetuximab is not excreted via the kidneys, its use in patients on hemodialysis has not been reported. We present the case of a 65-year-old man undergoing hemodialysis, with stage IVA squamous cell carcinoma of the hypopharynx. Given the logistics of performing hemodialysis immediately postcisplatin, he received concurrent chemoradiotherapy with cetuximab. He tolerated treatment well with minor side effects. Cetuximab can be safely used in patients with renal impairment. This is the first reported case of the use of cetuximab in a patient undergoing hemodialysis.

Squamous Cell Carcinoma of the Oral Cavity in the Elderly

As the population of older patients continues to grow and impact society, especially in developed countries, these individuals will require more medical attention. As such, it is important to compare the survival rates of patients suffering from oral squamous cell carcinoma beyond 65 years of age with younger patients. A retrospective review of 418 patients diagnosed and treated between 2004 and 2006 for squamous cell carcinoma of the oral cavity at Mackay Memorial Hospital was carried out. Patients were divided two groups with a cut-off age of 65. Staging, overall survival and disease-free survival were determined for both populations. There were no significant differences between the two groups in stage I ( p = 0.901 in overall survival [OS], p = 0.889 in disease-free survival [DFS]), stage II ( p = 0.345 in OS, p = 0.169 in DFS), stage III ( p = 0.348 in OS, p = 0.119 in DFS), stage IVB ( p = 0.234 in OS, p = 0.236 in DFS) or stage IVC ( p = 0.086 in OS). The survival after treatment was better in the younger group than the older group for stage IVA ( p = 0.009 in OS, p = 0.005 in DFS). Squamous cell carcinoma of the oral cavity did not have a significantly different outcome for elderly patients when compared with younger patients. Elderly patients with stage IVA squamous cell carcinoma of the oral cavity had poorer survival rates. When properly evaluated and monitored, conservative and conventional therapies seemed efficacious in the elderly.

Stage IVa squamous cell carcinoma of the vulva managed with primary chemoradiation

We present the case of a 53-year-old woman with International Federation of Gynecology and Obstetrics stage IVa (T3N2M0) squamous cell carcinoma of the vulva. Because the urethra was surrounded by a vulvar tumor, she was managed with primary chemoradiation in an attempt to spare the morbidity associated with exenterative vulvar surgery. Treatment was given as a planned split course, consisting of two separate courses of 23.8 Gy each. During each split course of radiation, 5-fluorouracil, 1000 mg/m2 per day, was given over the first 4 days, and cisplatin 50 mg/m2 was administered as a single infusion on the first day. During the 4 days of chemotherapy infusion, the radiation was administered in two daily fractions of 1.7 Gy each, given at least 6 h apart. There was no treatment break due to adverse effect, and a pathological complete response was achieved in the primary tumor and the lymph nodes. The patient did not undergo surgical intervention, and has had no evidence of recurrence for 24 months. Chemoradiation therapy should be considered as an option in patients with locally advanced vulvar cancer to avert the need for exenterative surgery, and to preserve sexual, gastrointestinal, and urinary function.

Rapid Progression of Primary Vaginal Squamous Cell Carcinoma in a Young HIV-Infected Woman

Background. The association of human immunodeficiency virus (HIV) infection with rapid progression of cervical and anal squamous cell carcinoma has been clearly established by several studies. Human papilloma virus (HPV) infection of the anogenital tract is believed to be the causative agent of cervical, anal, vaginal, and vulvar squamous cell carcinoma. While a myriad of reports exist in the literature pertaining to the rapid progression of cervical and anal carcinoma in HIV-infected patients, no association of HIV infection and vaginal carcinoma has been reported. We present an unusual case of a young woman infected with HIV who was diagnosed with advanced vaginal carcinoma and succumbed to her disease shortly thereafter despite aggressive treatment.Case. A 40-year-old woman with a 2-year history of HIV infection presented with Stage IVA squamous cell carcinoma of the vagina and a large vesicovaginal fistula from the tumor eroding through the posterior bladder wall. Computed tomography (CT) of the abdomen and pelvis revealed a large tumor replacing the vagina with mild hydronephrosis and diffuse pelvic and inguinal lymphadenopathy. She underwent urinary diversion with a transverse colon conduit followed by pelvic radiation with weekly cisplatin chemosensitization. A repeat CT scan of the abdomen and pelvis upon completion of her treatment revealed progression of disease with multiple liver metastases and gastrohepatic ligament adenopathy. She subsequently died of advanced metastatic vaginal carcinoma 2 months after completion of treatment.Conclusion. Due to the rarity of primary vaginal carcinoma, the clinical behavior of this neoplasm in the HIV-infected patient is poorly understood. Our case indicates that, although vaginal carcinoma is a disease of the elderly, young women infected with HIV and HPV are predisposed not only to develop cervical or anal carcinoma but also may be at increased risk for vaginal carcinoma with more aggressive and less responsive disease. Furthermore, although vaginal carcinoma is usually a slow-growing neoplasm, this case illustrates the aggressive behavior of such a tumor when associated with HIV infection.

Hemolytic-uremic syndrome associated with neoadjuvant chemotherapy in the treatment of advanced cervical cancer

Hemolytic-uremic syndrome (HUS) is a rare but severe complication of neoplastic disease as well as some of its treatments. The pathophysiology of HUS is poorly understood, but it affects multiple organ systems and carries a high mortality rate. The diagnosis of HUS is based on a clinical triad of microangiopathic hemolytic anemia (MAHA), thrombocytopenia, and renal failure, for which no proven therapies exist. This report describes a case of HUS developing in a patient with stage IVA squamous cell carcinoma of the uterine cervix following treatment with cisplatin/bleomycin/vincristine neoadjuvant chemotherapy prior to radiation therapy.