Gynandroblastoma with juvenile granulosa cell and Sertoli Leydig cell as components is an extremely rare tumor of sex-cord stromal variety and its occurrence as a recurrent poorly differentiated Sertoli Leydig cell tumor with heterologous rhabdomyosarcoma component is even a rarer event. A 14 years old female presented to us in our outpatient department with complaints of a pelvic mass and masculinizing symptoms. She was evaluated at our hospital and underwent primary upfront surgery; laparotomy with left salpingo-oophorectomy (ovarian mass excision) with retroperitoneal lymph node dissection with omentectomy. The histopathology of ovarian mass showed both juvenile granulosa cell and Sertoli Leydig differentiation, diagnosed as gynandroblastoma. The patient developed recurrence with a disease-free interval of 23 months and underwent secondary cytoreductive surgery for the same. The second histopathology report was suggestive of rhabdomyosarcoma; embryonal type (heterologous differentiation in sex cord stromal tumor). The case presented as a pathologist’s dilemma as adjuvant chemotherapeutic regimens changed based on the dominant component of the tumor. Also, as intra-operatively the tumor was extremely vascular, its surgical management proved to be a nightmare for the operating surgeon.

• Non-functional larynx (NFL) was found to affect 30.9 % of patients with locally advanced laryngeal cancer who underwent curative non-surgical laryngeal preservation treatment for stage III/IV disease • The key measures of NFL were long-term gastrostomy and tracheostomy dependence, functional laryngectomy and chronic aspiration. • Multivariate analyses identified current smoking to be associated with 6.8-fold increase in NFL • Patients with pre-treatment hemi-laryngeal fixation were 3.4 times more likely to experience locoregional recurrence.

Nowadays, the clinical application of antitumor drugs tends towards precision and individualization. Numerous efforts have been put in exploiting technologies to precisely discern the features of tumors and discover the possible response of every cancer patient to antitumor drugs at multiple dimensions from genes, proteins, tissues to whole organism, including Genomic data, histological information, functional drug profiling and drug metabolism of cancer patients can be obtained through polymerase chain reaction, sanger sequencing, next-generation sequencing, fluorescence in situ hybridization, immunohistochemistry staining, patient-derived tumor xenograft models, patient-derived organoid models and therapeutic drug monitoring. The application of various detection technologies in clinical practice has enabled ‘individualized treatment’ to be realized, but the ideal accuracy effect has not yet been achieved. More novel technologies or technology combinations are needed to predict the correlation between detection information and therapeutic effect, and to put forward more accurate and effective therapeutic strategies for every patient. Here, we briefly summarize the conventional and state-of-the-art technologies contributing to the clinical individualized medication and their application in clinical practice, attempting to seek therapy options that may ultimately improve clinical outcomes.

Trigeminal trophic syndrome is a rare cause of persistent secondary facial ulceration due to trigeminal nerve damage. Lesions often mimic squamous cell carcinoma but can be differentiated histologically. We present an unusual case of trigeminal trophic syndrome with both clinical and histologic features of squamous cell carcinoma.

Background There is evidence gastrointestinal (GI) motility may play a role in the development of GI cancers. Weak opioids (codeine and dihydrocodeine) decrease GI motility, but their effect on GI cancer risk has not been assessed. Aim To assess the association between weak opioids and cancers of the GI tract. Methods A series of nested case-control studies was conducted using Scottish general practice records from the Primary Care Clinical Informatics Unit Research database. Oesophageal (n=2,432), gastric (n=1,443), and colorectal cancer (n=8,750) cases, diagnosed between 1999 and 2011, were identified and matched with up to five controls. Weak opioid use was identified from prescribing records. Odds ratios (OR) and 95% confidence intervals (CI) were calculated using conditional logistic regression, adjusting for relevant comorbidities and medication use. Results There was no association between weak opioids and colorectal cancer (adjusted OR=0.96, CI 0.90, 1.02, p=0.15). There was an increased risk of oesophageal (adjusted OR=1.16, CI 1.04, 1.29, p=0.01) and gastric cancer (adjusted OR=1.26, CI 1.10, 1.45, p=0.001). The associations for oesophageal cancer, but not gastric cancer, were attenuated when weak opioid users were compared with users of another analgesic (adjusted OR=1.03 CI 0.86, 1.22, p=0.76 and adjusted OR=1.29 CI 1.02, 1.64, p=0.04 respectively). Conclusion In this large population-based study, there was no consistent evidence of an association between weak opioids and oesophageal or colorectal cancer risk, but a small increased risk of gastric cancer. Further investigation is required to determine whether this association is causal or reflects residual confounding or confounding by indication.

We report a case of radiation-induced myofibroblastoma of the right nasal cavity in a patient with a remote history of radiotherapy for pediatric retinoblastoma. The patient required maxillectomy and ethmoidectomy. To our knowledge, a rare number of cases have been reported in this location.

The authors herewith present a case of a non-conventional use of endotracheal tube-based IONM in a second-stage total thyroidectomy for metastatic papillary cancer incidentally detected after OPHL Type IIa + ary left for SCC. The use of the IONM in such case was effective avoiding the RLN accidental injury.

Erdheim-Chester disease is a rare multisystemic disease. A 50-year-old woman, presented with a recurrent pain and swelling of the left knee. Bone scintigraphy showed increased tracer uptake of peripheral skeleton. The computed tomography showed tissular infiltration in the retroperitoneum, around the vessels. Immunohistochemistry showed CD68 (+) and CD1a (-).

Background/objectives: Ataxia Telangiectasia (A-T) is a complex inherited disease that is associated with an increased risk of malignancy. Surveillance guidelines have demonstrated significant health benefits in other cancer predisposition syndromes (CPS). Evidence-based guidelines for cancer screening are not currently used in the UK for people affected by A-T. This study aims to understand how people with A-T and their parents feel about cancer surveillance using whole-body MRI to inform the future development of cancer surveillance guidelines. Design/Methods: We conducted semi-structured interviews of people affected by A-T. Data were analysed inductively using thematic analysis. Results: Nine parents of children with A-T and four adults with A-T were interviewed. Five main themes emerged from the data. All participants viewed cancer screening for children with A-T as invaluable and emphasised the perceived value of early detection. The second theme acknowledged the anxiety associated with cancer and cancer surveillance and the third theme highlighted the perceived limitations around current practice, with the responsibility for monitoring falling too strongly on parents and patients. The fourth theme identified the need for effective preparation for cancer screening, including clear communication, and the challenges of MRI screening were recognised in the fifth theme with specific recommendations made for improving the child’s experience. Conclusion: This study suggests that stakeholders are positive about the perceived advantages of a cancer screening programme. Ongoing support and preparation techniques should be adopted to maximise adherence and minimise adverse psychosocial outcomes.

we report the case of a 61-year-old male patient who was admitted with abdominal pain, vomiting and constipation. he had a past medical history of epidermoid lung cancer .computed tomography revealed distended stomach with mural bowel thickening. it was peroperatively two small-bowel metastasis from lung cancer that we resect.

We report an uncommon case of pelvic telangiectatic osteosarcoma in a young diabetic female who presented with a two-year history of a painless limp. The clinical, radiological, and pathological features of telangiectatic osteosarcoma of the pelvis and discuss how uncommon symptoms can lead to diagnostic delay of the disease.

Facial puffiness as a consequence of superior vena cava syndrome (SVCS), can be a presentation from which the physician would have to conjecture a diagnosis of a mediastinal mass including lymphomas. Pediatric SVCS can rapidly progress and pose a greater challenge for airway protection as was in our case.

Various conditions may mimic osteosarcoma. The differential diagnosis of osteosarcoma is broad. A proper history, examination, diagnostic imaging studies, and pathological analysis are essential to establish the precise diagnosis. This case report serves to illustrate the significance of recognizing similarities and other rare features to prevent late or misdiagnosis.

Aims Protein kinase inhibitors (PKI) have revolutionized the prognosis of several types of cancer, justifying the acceleration of their clinical evaluation before they obtain marketing authorization. Pharmacovigilance signals of heart failure (HF) following exposure to PKIs have been detected in recent years. Our objective was to identify the PKIs most frequently associated with the development of HF. Methods Using the French National Healthcare Database, all patients newly exposed to a PKI between January 2011 and June 2014 were followed up for 18 months. Specific hospitalisation diagnosis and long-term disease codes related to HF were used to identify HF patients. HF Incidence Rate Ratios (IRR) were measured and adjusted Hazard Ratios (aHR) were estimated using a Cox model. Results Thirteen PKIs were studied. Among the 49,714 new PKI users during the study period, the mean IRR of HF was 3.38 per 100 person-years, with a median time to onset of 155 days. We found a significant increase in the incidence of HF for 6 drugs: pazopanib (aHR= 2.42, 95% CI: 1.67-3.52), dasatinib (aHR= 2.22, 95% CI: 1.42-3.44), ruxolitinib (aHR= 2.11, 95% CI: 1.69-2.64), crizotinib (aHR= 1.71, 95% CI: 1.07-2.72), everolimus (aHR= 1.45, 95% CI: 1.26-1.67) and vemurafenib (aHR= 1.37, 95% CI: 1.01-1.86). Conclusions Our study provides knowledge on HF following exposure to a PKI. Additional studies could confirm these results for dasatinib, everolimus, pazopanib and ruxolitinib, and particularly for the two drugs with results slightly above the significance threshold, crizotinib and vemurafenib in our sensitivity analyses.

The iliac vein is an extremely rare site of metastasis for extraskeletal mesenchymal chondrosarcoma (ESMC). Involvement of the veins usually leads to an extremely dismal prognosis.

Herein, we report two cases of patients diagnosed with nivolumab-refractory distant metastatic squamous cell carcinoma of the tongue who were successfully treated with a combination of paclitaxel and cetuximab, thus demonstrating that some nivolumab-refractory patients with recurrent or distant metastatic oral squamous cell carcinoma may benefit from subsequent salvage chemotherapy.

We report a case in which it was difficult to distinguish cervical lymph node involvement from Hodgkin's lymphoma vs cervical lymph node metastasis from tongue cancer. Additionally, we report the histopathology for a postoperative follow-up biopsy of an enlarged lymph node in this patient with Hodgkin's lymphoma in remission.

Background: Poly ADP-ribose polymerase (PARP) inhibitors have emerged as maintenance therapy for advanced ovarian cancer. However, due to the development of drug resistance, combination of PARP inhibitors with other chemotherapeutic agents has become a contemporary research hotspot. Methods: We conducted a meta-analysis of phase II or III randomized controlled trials to analyze the efficacy and safety of combinations of PARP inhibitors with various chemotherapeutic agents on the progression-free survival (PFS) and overall survival (OS) of patients with ovarian cancer. Results: A total of eight trials that contained the combination of PARP inhibitors and chemotherapeutic agents were included. Combination of PARP inhibitors with bevacizumab benefited patients with BRCA mutations and HRD-positive status(HR=0.34 (95% Cl: 0.23–0.5; P<0.05); HR=0.35 (95% Cl: 0.27–0.45; P<0.05)), while combination with chemotherapy prolonged the PFS in the BRCA mutation, HRD, and homologous recombination proficiency subgroups(HR=0.39 (95% Cl: 0.26–0.58; P<0.05);HR=0.57 (95% Cl: 0.43–0.76; P<0.05); HR=0.79 (95% Cl: 0.64–0.98; P<0.05) ). However, patients with BRCA wild-type or unknown type benefited most from combination with cediranib. PARP inhibitors increased the risk of G≥3 neutropenia when combined with bevacizumab(RR=2.25, 95% Cl 1.09–4.62; P<0.05) and G≥3 anemia(RR=1.54, 95% Cl 1.16–2.05; P<0.05) and neutropenia(RR=1.25,95% CL 1.00-1.57; P<0.05) when combined with chemotherapy. Conclusion: Combination regimens of PARP inhibitors showed benefits in both primary and recurrent ovarian cancer, and the population subsets benefiting varied among different combinations. G≥3 adverse reactions were mainly hematological toxicities.

Fibrolipoma is a variant of lipoma that is relatively uncommon in the mouth tissues, especially the attached gingiva. It is diagnosed by histopathologic and immunohistochemistry evaluation and treated by total excision. A case of a patient with attached gingiva fibrolipoma, treated by surgical excision under local anesthesia is reported.

A document by Elias Tsakos, written on Authorea.

Anaplastic thyroid cancer is a rare and has an extremely poor prognosis. It is known that most of anaplastic transformation occurs in primary lesions, but rarely in metastatic lesions. We report 67-year-old female patient who recieved surgery, but whose postoperative pathological examination revealed anaplastic transformation in metastatic cervical lymph nodes.

This case report describes of a pharmacokinetic drug–drug interaction between crizotinib, a tyrosine kinase inhibitor, and sofosbuvir/velpatasvir, a direct-acting antiviral drug, leading to cardiac toxicity. A 75-year-old man, with no cardiovascular history but a diagnosis of metastatic non-small cell lung cancer with MET exon-14 deletion and hepatitis C virus infection genotype 1A, received both crizotinib and sofosbuvir/velpatasvir. Crizotinib was well tolerated, but 1 week after sofosbuvir/velpatasvir initiation, the patient experienced bilateral lower-limb edema and class III NYHA dyspnea. We assumed that increased exposure to crizotinib could account for this cardiac toxicity. Drug causality was probable according to the Naranjo scale. We hypothesized a reciprocal interaction between crizotinib and velpatasvir, mediated by both cytochrome 3A4 (CYP3A4) and P-glycoprotein (P-gp). Clinicians should be aware of the risk of drug–drug interactions between direct-acting antiviral agents that inhibit CYP3A4 (glecaprevir) and/or P-gp (voxilaprevir) and anticancer tyrosine kinase inhibitors that are mostly CYP3A4 and/or P-gp substrates (gefitinib, afatinib, erlotinib, crizotinib, ceritinib, lorlatinib, brigatinib, capmatinib etc.).

Bladder cancer treatment remains a challenge to every oncologist. We report the case of a 57-year-old man with BCG-refractory bladder cancer, who had a complete response to the intravesical Gemcitabine to shine the light on the role of Gemcitabine as a bladder sparing treatment in BCG-failure patients.

A 69-year-old man presented with bloody pleural fluid effusion with elevated human chorionic gonadotropin (hCG) levels obtained by thoracentesis. The patient’s condition rapidly declined, and he died. An autopsy revealed primary lung choriocarcinoma. The early diagnosis of choriocarcinoma based on β-hCG levels in pleural fluid may be possible.