Case Reports in Oncological Medicine The latest articles from Hindawi Publishing Corporation © 2014 , Hindawi Publishing Corporation . All rights reserved. Importance of HER2 Work-Up and Treatment Even in Patients with Poor Performance Status: A Case Report Sun, 13 Apr 2014 15:34:30 +0000 Gastric cancer is one of most common types of cancers. Metastatic gastric cancer has a poor prognosis and is accepted as incurable at this stage. Treatment of metastatic gastric cancer did not progress substantially until new targeted agents have come out. Recently published ToGA trial showed promising results in HER2 overexpressing metastatic gastric cancer. In this case we present a case with an excellent complete response with anti-HER2 treatment. Most importantly, we wanted to emphasize (1) the importance of early determination of HER2 overexpression, and (2) to draw attention of anti-HER2 agents in the first line treatment even in patients with a poor performance status. Ali Suner, Hakan Buyukhatipoglu, Ozan Balakan, Mehmet Emin Kalender, Turgay Ulas, Alper Sevinc, and Celalettin Camci Copyright © 2014 Ali Suner et al. All rights reserved. A Rare Case of a Synchronous Anaplastic Carcinoma Thyroid with Ductal Carcinoma Breast Sun, 13 Apr 2014 00:00:00 +0000 Dual malignancy was first reported by Billroth in 1889. Incidence of second malignancy in cancer patients is as high as 10%, but synchronous anaplastic thyroid cancer along with breast tumor is a rare entity. We present a case of a 61-year-old female with a synchronous anaplastic carcinoma thyroid with ductal carcinoma breast. The plausible association of breast cancers with thyroid carcinomas should thus be evaluated in larger cohort studies. More importantly, this report is to highlight the unusual synchronous occurrence of anaplastic thyroid cancer with ductal breast cancer and the therapeutic challenges involved in such cases. Saptarshi Ghosh, P. B. Ananda Rao, Shreyasee Sarkar, Sivasankar Kotne, S. P. V. Turlapati, and Anindita Mishra Copyright © 2014 Saptarshi Ghosh et al. All rights reserved. Combination Therapy of Albumin-Bound Paclitaxel and Carboplatin as First Line Therapy in a Patient with Ovarian Cancer Thu, 03 Apr 2014 11:51:29 +0000 Background. Ovarian cancer is the ninth most common cancer among women and causes more deaths than any other type of female reproductive cancer. Albumin-bound paclitaxel is known to increase intratumoral concentration of the paclitaxel by a receptor-mediated transport process across the endothelial cell wall, thereby breaching the blood/tumor interface. We present below three cases in which nab-paclitaxel based chemotherapy has been used in different settings for patients with ovarian cancer. Case Presentation. In the first case nab-paclitaxel was used along with carboplatin in adjuvant setting, in the second case, nab-paclitaxel was used along with carboplatin and bevacizumab as second line chemotherapy in a relapsed ovarian cancer case, and the third case delineates the use of nab-paclitaxel along with cisplatin as third line chemotherapy. Conclusion. In all the three scenarios, patients tolerated the chemotherapy well, as well as responding well to nab-paclitaxel based chemotherapy. The patients are currently on long-term follow-up and have been having an uneventful postchemotherapy. K. N Srinivasan, Amit Rauthan, and R. Gopal Copyright © 2014 K. N Srinivasan et al. All rights reserved. Oligodendroglioma Arising in Mature Cystic Teratoma Sun, 16 Mar 2014 14:16:09 +0000 Background. Development of neuroepithelial tumors from mature cystic teratoma is very rare. We present a case of oligodendroglioma developing inside mature cystic teratoma. Case. Eighteen-years-old female, right adnexal mass with solid and cystic areas was detected. Sections showed all three germ layers. Also, a tumoral lesion was observed in a glial fibrillary matrix. Tumor was composed of monotonous, uniform cells which have oval-round nucleus, perinuclear halo, and indistinct cytoplasm. GFAP, EGFR, P53 were positive. Conclusions. We diagnosed oligodendroglioma arising from mature cystic teratoma. There was no recurrence at the end of 13 months followup. The number of cases which have been reported in the literature is only a few. Betül Ünal, Faruk Güleç, and Murat Şedele Copyright © 2014 Betül Ünal et al. All rights reserved. Lung Metastasis after an Eighteen-Years-Long Disease-Free Period since Uterine Leiomyosarcoma Diagnosis Wed, 12 Mar 2014 11:43:46 +0000 Uterine leiomyosarcoma (ULMS) is an uncommon malignancy that accounts for one-third of uterine sarcomas and represents 1% of all uterine malignancies, with an incidence averaging 0.5–1/100,000/year. The prognosis is poor due to its intrinsic aggressiveness and its characteristic high metastatic potential with reported distant metastatic spread in lung, abdomen, soft tissue, and brain. We present the case of a 67-year-old woman with lung metastasis after eighteen years since uterine leiomyosarcoma diagnosis and its following surgical resection. The diagnosis of pulmonary metastases was obtained by reviewing the histology of the previous uterine tumor: the tumor cells were immunoreactive for CD10, PR, and smooth muscle actin (SMA), but negative for desmin, S100, CD34, CD 117, cytokeratins AE1AE3, CD68R, and ER. To our knowledge, this disease-free interval is the longest among previous reports of pulmonary metastasis of uterine leiomyosarcoma. M. Guazzaroni, D. Tosti, M. Rascioni, M. Mataloni, D. Citraro, and G. Simonetti Copyright © 2014 M. Guazzaroni et al. All rights reserved. Management of a Patient with Metastatic Colorectal Cancer and Liver Metastases Wed, 12 Mar 2014 09:30:12 +0000 Liver metastases are commonly encountered in patients presenting with metastatic colorectal cancer (mCRC); resection is the treatment of choice. A number of systemic treatment options are currently available for such patients, including the use of 5-fluorouracil-based chemotherapies and oxaliplatin (e.g., FOLFOX) in combination with biologic agents that target angiogenesis (e.g., bevacizumab). For patients with progression following first-line treatment, current second-line options include a change in chemotherapy with bevacizumab (for patients who did or did not receive prior bevacizumab) or FOLFIRI in combination with aflibercept, a more recently approved antiangiogenesis therapy. Neurotoxicity is a well-established adverse event of oxaliplatin-based therapy. The current case details an mCRC patient with liver metastases who was treated with a capecitabine and oxaliplatin regimen (XELOX), and experienced two episodes of transient cortical blindness possibly related to oxaliplatin. After disease progression, the patient was switched to a regimen of FOLFIRI and aflibercept and did well on this second-line regimen. Muhammad Wasif Saif Copyright © 2014 Muhammad Wasif Saif. All rights reserved. Choroidal Metastasis from Follicular Cell Thyroid Carcinoma Masquerading as Circumscribed Choroidal Haemangioma Tue, 11 Mar 2014 06:27:27 +0000 Choroidal metastases from follicular thyroid carcinoma are uncommon and usually present as an amelanotic lesion against a background of known systemic disease. We present the case of a 56-year-old woman with a thyroid metastatic focus with unusual clinical presentation, systemic involvement, and early response to systemic treatment. A review of the literature accompanies this case presentation. V. P. Papastefanou, A. K. Arora, J. L. Hungerford, and V. M. L. Cohen Copyright © 2014 V. P. Papastefanou et al. All rights reserved. An Innocent Appearing Subcutaneous Nodule Diagnoses a Small Cell Lung Cancer in a Never-Smoker Female Mon, 10 Mar 2014 11:52:14 +0000 Lung cancer among never-smokers is recognized as the 7th most common cause of cancer death globally. Adenocarcinoma is the most commonly reported histology. Small cell lung cancer (SCLC) has the strongest association with smoking and is rarely reported in never-smokers. Although lung cancer in never-smokers is more common in women, the overall incidence of SCLC in female never-smokers still remains low. Soft tissue metastases from any cancer are rare with an overall prevalence of 1.8%. Soft tissue metastases from lung primary are uncommon, mostly from adenocarcinoma, and portend a poor prognosis. Cutaneous metastases from SCLC are exceptionally rare with reported incidence of 0.3% to 0.8%. We believe ours is the first reported case of SCLC presenting as subcutaneous nodule, in a never-smoker, otherwise asymptomatic female. The diagnosis of SCLC was made incidentally by the excisional biopsy of the subcutaneous nodule. Subsequent CT chest and PET scan revealed a hypermetabolic right lower lobe spiculated lung mass with adrenal and liver involvement. Platinum and etoposide chemotherapy with prophylactic cranial irradiation was initiated for advanced SCLC, and she required further irinotecan and taxol for subsequent pancreatic and adrenal metastases. With continued deterioration, she died approximately 36 months from diagnosis, while under hospice care. Nupur Sinha, Masooma Niazi, Gilda Diaz-Fuentes, and Richard Duncalf Copyright © 2014 Nupur Sinha et al. All rights reserved. Multiple Cutaneous Angiosarcomas after Breast Conserving Surgery and Bilateral Adjuvant Radiotherapy: An Unusual Case and Review of the Literature Wed, 05 Mar 2014 09:42:33 +0000 Breast angiosarcomas (BAs) are rare but serious events that may arise after radiation exposure. Disease outcome is poor, with high risk of local and distant failure. Recurrences are frequent also after resection with negative margins. The spectrum of vascular proliferations associated with radiotherapy in the setting of breast cancer has expanded, including radiation-associated atypical vascular lesions (AVLs) of the breast skin as a rare, but well-recognized, entity. Although pursuing a benign behavior, AVLs have been regarded as possible precursors of postradiation BAs. We report an unusual case of a 71-year-old woman affected by well-differentiated bilateral cutaneous BA, diagnosed 1.9 years after adjuvant RT for synchronous bilateral breast cancer. Whole-life clinical followup is of crucial importance in breast cancer patients. Icro Meattini, Raffaella Santi, Daniele Scartoni, Irene Giacomelli, Carla De Luca Cardillo, Vieri Scotti, Donato Casella, Roberta Simoncini, Lorenzo Orzalesi, Jacopo Nori, Milena Paglierani, and Lorenzo Livi Copyright © 2014 Icro Meattini et al. All rights reserved. A Unique Case of Malignant Pleuropericardial Effusion: HHV-8-Unrelated PEL-Like Lymphoma—A Case Report and Review of the Literature Tue, 04 Mar 2014 13:32:51 +0000 Primary effusion lymphoma (PEL) or body cavity lymphoma is a rare type of extra nodal lymphoma of B-cell origin that presents as lymphomatous effusion(s) without any nodal enlargement or tumor masses. It belongs to the group of AIDS related non-Hodgkin’s lymphomas. First described in 1996 in HIV infected individuals who were coinfected with Kaposi’s sarcoma-associated herpesvirus (KSHV) or HHV-8 virus, it was included as a separate entity in WHO classification of tumors of hematopoietic and lymphoid tissue in the year 2001. The definition included association with HHV-8 virus as a mandatory diagnostic criterion. However, cases were later reported where PEL-like disease process was diagnosed in HHV-8 negative patients. This was eventually recognized as a rare but distinct entity termed as “HHV-8-unrelated PEL-like lymphoma”. Herein, we are reporting a case of an elderly patient who presented with a large pleuropericardial effusion and was eventually diagnosed with this entity. Till date, only around 50 cases of HHV-8-unrelated PEL-like lymphoma have been reported and our case being EBV, HIV, and Hepatitis C negative makes it very unique and rare occurrence. We are also presenting a review of relevant literature focused mainly on comparing outcomes in patients treated with and without chemotherapy. Farhan Mohammad, Muhammad Neaman Siddique, Faraz Siddiqui, M. Popalzai, Masoud Asgari, and Marcel Odaimi Copyright © 2014 Farhan Mohammad et al. All rights reserved. A Case of Recurrent Breast Cancer with Solitary Metastasis to the Urinary Bladder Tue, 04 Mar 2014 12:37:15 +0000 Elderly patients with breast cancer often present with symptomatic, locoregionally advanced rather than screening-detected disease, thereby increasing the risk of metastatic recurrence during their remaining life time. Typical sites of metastases include lungs, bones, liver, and brain. Here we present a patient who developed a solitary urinary bladder metastasis five years after primary diagnosis of stage T4 N0 estrogen receptor-positive lobular carcinoma, while on continued adjuvant endocrine treatment (91 years of age). Anemia and increased serum creatinine resulting from hydronephrosis led to diagnosis of metastatic disease, which was confirmed by transurethral resection. The patient responded clinically to palliative radiotherapy and a different type of endocrine therapy. One year after diagnosis of metastatic disease, she died without signs of cancer progression. Carsten Nieder and Adam Pawinski Copyright © 2014 Carsten Nieder and Adam Pawinski. All rights reserved. Primary Pleural Benign Myxoid Schwannoma in an 18-Year-Old Female: A Case Report and Literature Review Tue, 04 Mar 2014 12:17:46 +0000 Pleural schwannomas are exceedingly rare neoplasms of the thoracic cavity. To the best of our knowledge, less than 20 cases have been reported in the medical English literature. Herein, we report the case of primary pleural benign myxoid schwannoma in an 18-year-old female. The patient was originally referred to our tertiary care hospital for further management of right adrenal gland mass. Physical examination and all laboratory tests were normal. Contrast-enhanced computed tomography scan showed a  cm, heterogeneous noncalcified mass involving the right adrenal gland region. The right renal vein and inferior vena cava were intact. There was no pleural effusion, ascites, or lymphadenopathy. No pelvic masses were identified. Patient was scheduled for surgical resection. On laparotomy, the mass was not found in its radiologically expected location, and the right kidney and right adrenal gland were intact. The right-sided lower part of diaphragm was opened, and the mass was interestingly found inside the thorax attached to the pleura, and resected successfully. A final histopathological diagnosis of primary pleural benign myxoid schwannoma was established. At a postoperative 6-month followup, there was no radiological evidence of tumor recurrence. Furthermore, literature review on pleural schwannomas is also presented. Hussam Abou Al-Shaar, Safi Qutob, Ahmed Abu-Zaid, Ayman Azzam, Tarek Amin, and Shamayel Mohammed Copyright © 2014 Hussam Abou Al-Shaar et al. All rights reserved. Sarcoidosis Associated with Oxaliplatin-Based Chemotherapy for Colorectal Cancer Tue, 04 Mar 2014 08:55:48 +0000 Acute lung injury occasionally occurs after chemotherapy, but pulmonary toxicities by oxaliplatin-based chemotherapy have rarely been identified. A 76-year-old female with rectosigmoid colon cancer presented with ongoing dyspnea after the eighth cycle of standard chemotherapy (5-fluorouracil, sodium folinic acid, and oxaliplatin: FOLFOX). Nodular consolidation progressed despite antibiotics and BAL fluid analysis was compatible with the diagnosis of sarcoidosis. Corticosteroid therapy rapidly improved the symptoms and radiographic findings. We report this first case of secondary sarcoidosis related to FOLFOX therapy with review of references. Ji Hoon Choi, Jung A. Shin, Hye Kyeong Park, Su Young Kim, Hoon Jung, Sung-Soon Lee, Hye Ran Lee, and Hyeon-Kyoung Koo Copyright © 2014 Ji Hoon Choi et al. All rights reserved. Clear Cell Adenocarcinoma of the Colon: A Case Report and Review of the Literature Tue, 04 Mar 2014 08:52:01 +0000 Clear cell adenocarcinoma of the colon has been described scarcely in the literature. It affects elderly men more commonly than women and usually appears in the left side of the colon. A Hispanic 41-year-old female came to the emergency room with abdominal pain, vomiting, and distension. Physical exam revealed generalized tenderness without peritoneal signs. Laboratory data was unremarkable. A CT scan showed an apple-core lesion in the distal colon. A flexible sigmoidoscopy revealed an obstructive mass that made further evaluation impossible. Exploratory surgery revealed a hard mass obstructing the descending colon, which was resected. Histopathology analysis with immunohistochemistry staining was positive for cytokeratin 20, cytokeratin 10, CDX2, and villin, while it was negative for cytokeratin 7, RCC, vimentin, and CD31. These results confirmed the clear cell variant of the adenocarcinoma. Clear cell adenocarcinomas usually arise from the kidneys and Müllerian organs. Immunohistochemistry is crucial for establishing the origin of these neoplastic cells. A cytokeratin 20+/7− with positive CDX2 is highly specific and sensitive for intestinal neoplastic origin. The main treatment has been surgery alone with moderately good results. More research and information about this malignancy is needed, especially in regard to prognosis and in order to provide the best treatment option. Christian Daniel Barrera-Maldonado, Isidoro Wiener, and Sue Sim Copyright © 2014 Christian Daniel Barrera-Maldonado et al. All rights reserved. Infected Osteoclastoma of the Knee: An Unusual Presentation Tue, 04 Mar 2014 08:40:33 +0000 Introduction. Giant cell tumor is a benign or locally aggressive tumor of uncertain origin that appears in mature bone, most commonly in the distal femur, proximal tibia which characteristically extends right up to the subarticular bone plate. Case Report. We report here a 35-year-old female presenting with swelling of the left knee. On examination, the swelling was solitary, about 20 × 15 cm in size with the skin over the swelling stretched and glistening. On the fifth day of hospital stay, the swelling burst open and blood tinged pus started pouring out. X-ray and MRI scan showed a well-defined T2 hyperintense expansile eccentrically located osteolytic lesion involving the metaphyseal region of the proximal tibia and extending into the subarticular space and multiple T1/T2 hypointense septations are noted within the lesion suggestive of osteoclastoma. The patient was counseled regarding the tumor and prognosis and various treatment options. She was treated successfully with above knee amputation. The tissue was sent for histopathology which confirmed osteoclastoma. Conclusion. It is important to recognize giant cell tumors early, so that they can be treated promptly with local measures to prevent morbidity and mortality in young adults. O. B. Pattanashetty, B. B. Dayanand, Yogesh Mapari, and Monish Bami Copyright © 2014 O. B. Pattanashetty et al. All rights reserved. Papillary Serous Carcinoma of the Uterine Cervix with Lung Metastasis Tue, 04 Mar 2014 07:38:12 +0000 Papillary serous carcinoma of the uterine cervix is a rare histological variant of cervical adenocarcinoma, with a very small number of cases reported. It is an aggressive tumor and is usually diagnosed at advanced stages by the time of diagnosis. Early-stage tumors can be treated with surgery and/or radiotherapy, while late-stage tumors have been treated with chemotherapy plus radical surgery with intermittent success. Here we report a case of metastatic papillary serous carcinoma observed at our hospital, which has been treated with debulking surgery and combination chemotherapy with carboplatin and paclitaxel. Maliha Khan, Alan D. Gilman, Sobia Nizami, Aram Barbaryan, Alaa M. Ali, and Aibek E. Mirrakhimov Copyright © 2014 Maliha Khan et al. All rights reserved. Severe Acute Radiation Dermatitis in a Patient with Argyria Mon, 03 Mar 2014 13:12:29 +0000 Argyria is a rare cutaneous condition due to dermal silver deposition leading to irreversible blue-grey discoloration. Acute radiation dermatitis (RD) is an expected toxicity in patients undergoing radiotherapy but it is unknown to what extent argyria affects the onset and severity of RD. We report a patient with argyria treated with concurrent chemoradiotherapy for Merkel cell carcinoma who experienced an unexpectedly brisk and severe RD during treatment. Possible mechanisms for this interaction are considered. P. Gorayski, M. B. Pinkham, J. B. Muir, and A. P. Pullar Copyright © 2014 P. Gorayski et al. All rights reserved. Advanced Ovarian Dysgerminoma Infiltrating Both Ovaries and Uterus in a 7-Year-Old Girl Sun, 23 Feb 2014 00:00:00 +0000 Introduction. Ovarian dysgerminoma is a rare malignant ovarian germ cell tumor with its peak incidence in young women. Abdominal pain, abdominal distention, and the presence of a palpable mass are common symptoms at presentation. Depending on the FIGO stage at presentation the prognosis of dysgerminomas after surgical treatment, adjuvant chemotherapy, and radiotherapy is promising. Case Presentation. A 7-year-old girl was presented at our clinic with abdominal pain in all abdominal quadrants. Later the pain localized in the region of her right ovary. CT scan revealed a massive formation which was connected to her right ovary. Conclusion. Although malignant ovarian germ cell tumours are rare in children, physicians must always consider the possibility of MOGT-occurrences. The clinical symptoms might not be specific: abdominal pain, abdominal distention, nausea, and vomiting. In order to make a correct diagnosis the patients should undergo a complete clinical examination including radiological scans. Initial management is frequently surgery, followed by adjuvant chemotherapy and radiotherapy. Although disgerminoma is malignant tumor, the prognosis is promising. Nexhmi Hyseni, Sadik Llullaku, Hysni Jashari, Kaltrina Zahiti, Fjolla Hyseni, Fisnik Kurshumliu, Lumturije Luci, Fehim Muqolli, and Antigona Hasani Copyright © 2014 Nexhmi Hyseni et al. All rights reserved. Pulmonary Adenocarcinoma Occurring 5 Years after Resection of a Primary Pancreatic Adenocarcinoma: A Relevant Differential Diagnosis Sun, 23 Feb 2014 00:00:00 +0000 Ductal adenocarcinoma of the pancreas is a lethal disease. Surgical extirpation only offers the slim chance for long-term survival in localized disease. We report on a 73 year old female patient who initially underwent successful resection of pancreatic adenocarcinoma in May 2005. She was treated with adjuvant chemotherapy with gemcitabine. In October 2010 the patient noticed increasing dyspnea with haemoptysis. She was soon referred to our center. After the diagnosis of pulmonary adenocarcinoma with widespread metastasis, she was treated with systemic chemotherapy. For a period of next three years, she was treated with different chemotherapy regimens due to repeated episodes of tumor progression. To the best of our knowledge after reviewing the literature, this case represents an unusually clinical course with metachronous pulmonary adenocarcinoma arising after treatment of a primary pancreatic cancer after a long latency period. R. F. Falkenstern-Ge, M. Wohlleber, M. Kimmich, K. Huettl, G. Friedel, G. Ott, and M. Kohlhäufl Copyright © 2014 R. F. Falkenstern-Ge et al. All rights reserved. A Multidisciplinary Approach to the Management of Atypical Osseous Epithelioid Hemangioendothelioma Tue, 18 Feb 2014 12:11:15 +0000 Hemangioendothelioma is a rare vascular tumor of intermediate malignant potential. Though epithelioid hemangioendothelioma (EH) is commonly found in soft tissues, it has been known to be present in skeletal tissues. The authors present a case of a 50-year-old woman diagnosed with EH of the iliac bone and acetabulum, who experienced pathological fracture at presentation. This report describes a multidisciplinary approach to the management that includes initial incisional biopsy, curettage, and bone grafting, followed by Intensity Modulated Radiation Therapy. The patient finally underwent hemipelvic resection with allograft reconstruction after recurrence. Histopathological study revealed osseous EH of low mitotic activity that stained positively for CD31, CD34, vimentin, and Factor VIII. Herein, the authors discuss the imaging characteristics, histopathological aspects, cytogenetic findings, and the radiobiological behavior of osseous EH. After an aggressive multidisciplinary intervention, the patient is able to achieve local control with no evidence of distal metastatic disease. J. K. Ma, J. Barr, and S. Vijayakumar Copyright © 2014 J. K. Ma et al. All rights reserved. Unusual Synchronous Lung Tumors: Mucoepidermoid Carcinoma and Mucinous Adenocarcinoma Tue, 18 Feb 2014 07:58:17 +0000 Primary mucoepidermoid tumors of the lung are rare entities. Synchronous primary malignancies of the lung involving mucoepidermoid carcinoma and mucinous adenocarcinoma are even rarer and constitute a unique set of patient population. The presentation, diagnosis and treatment strategies for this patient population are not well described. In most cases, the diagnosis of synchronous primary lung malignancy is made after pathological examination of the resected lung specimen. Molecular and genetic analysis is now being used to supplement the diagnosis of synchronous primary lung malignancies. In this work, we briefly discuss the current state of knowledge of this unique combination of primary lung malignancies and describe the clinical presentation and management of a patient with a rare combination of synchronous primary lung malignancies. Ana M. Ponea, Creticus P. Marak, Ying Sun, Achuta Kumar Guddati, and Amit S. Tibb Copyright © 2014 Ana M. Ponea et al. All rights reserved. Benign Metastasizing Leiomyoma: A Rare Type of Lung Metastases—Two Case Reports and Review of the Literature Wed, 12 Feb 2014 11:34:19 +0000 Benign metastasizing leiomyoma (BML) is a rare disease that usually occurs in women of reproductive age. They typically have history of uterine leiomyoma treated with hysterectomy. BML can metastasize to distant organs, with the lung being the most common organ. We report two patients who presented with benign metastasizing leiomyoma to the lung. Our first case was a fifty-two-year-old female who presented with multiple lung masses, with a past medical history of uterine leiomyoma who underwent hysterectomy 17 years ago. A CT-guided biopsy showed benign appearing spindle cells and pathology confirmed her diagnosis with additional positive estrogen/progesterone receptor stains. Our second case was a fifty-six-year-old female who presented with multiple cavitary pulmonary nodules. She subsequently underwent a video-assisted thoracoscopic surgery (VATS) with wedge resection of one of the nodules. Pathology confirmed the diagnosis based on morphology and immunohistochemical staining strongly positive for estrogen/progesterone receptors. Benign metastasizing leiomyoma is a rare condition which may affect women of reproductive age. This should be considered in the differential in patients who present with multiple pulmonary nodules, especially with a history of uterine leiomyoma. Additional stains, such as estrogen/progesterone receptors, may need to be done to confirm the diagnosis. Rokana Taftaf, Sandra Starnes, Jiang Wang, Ralph Shipley, Tariq Namad, Rana Khaled, and Nagla Abdel Karim Copyright © 2014 Rokana Taftaf et al. All rights reserved. Durable Hematological and Major Cytogenetic Response in a Patient with Isolated 20q Deletion Myelodysplastic Syndrome Treated with Lenalidomide Wed, 12 Feb 2014 08:50:26 +0000 Myelodysplastic syndrome (MDS) is a clonal bone marrow disorder characterized by ineffective hematopoiesis. It is characterized by peripheral blood cytopenia and significant risk of progression to acute myeloid leukemia result. Deletion of the long arm of chromosome 20 (20q deletion) is present in 3–7% of patients with MDS. Lenalidomide is an immunomodulatory agent with antiangiogenic activity. It is FDA approved for the treatment of anemia in patients with low or int-1 risk MDS with chromosome 5q deletion with or without additional cytogenetic abnormalities. Study of lenalidomide in patients with MDS without 5q deletion but other karyotypic abnormalities demonstrated meaningful activity in transfusion dependent patients; however, response of patients with isolated 20q deletion to lenalidomide is not known. We are reporting a patient with 20q deletion MDS treated with lenalidomide after he failed to respond to azacytidine; to our knowledge this is the first report of a patient with isolated 20q deletion treated with lenalidomide. Bagi Jana, Anas Khanfar, and Mary Ninan Copyright © 2014 Bagi Jana et al. All rights reserved. Acute Pancreatitis and Diabetic Ketoacidosis following L-Asparaginase/Prednisone Therapy in Acute Lymphoblastic Leukemia Mon, 10 Feb 2014 10:27:17 +0000 Acute pancreatitis and diabetic ketoacidosis are unusual adverse events following chemotherapy based on L-asparaginase and prednisone as support treatment for acute lymphoblastic leukemia. We present the case of a 16-year-old Hispanic male patient, in remission induction therapy for acute lymphoblastic leukemia on treatment with mitoxantrone, vincristine, prednisone, and L-asparaginase. He was hospitalized complaining of abdominal pain, nausea, and vomiting. Hyperglycemia, acidosis, ketonuria, low bicarbonate levels, hyperamylasemia, and hyperlipasemia were documented, and the diagnosis of diabetic ketoacidosis was made. Because of uncertainty of the additional diagnosis of acute pancreatitis as the cause of abdominal pain, a contrast-enhanced computed tomography was performed resulting in a Balthazar C pancreatitis classification. Dania Lizet Quintanilla-Flores, Miguel Ángel Flores-Caballero, René Rodríguez-Gutiérrez, Héctor Eloy Tamez-Pérez, and José Gerardo González-González Copyright © 2014 Dania Lizet Quintanilla-Flores et al. All rights reserved. Primary Malignant Mixed Müllerian Mesodermal Tumor Mimicking a Rectosigmoid Carcinoma: A Case Report and Review of the Literature Mon, 10 Feb 2014 00:00:00 +0000 We report a case of a 53-year-old female who presented with chronic constipation and abdominal discomfort for six months. Her past surgical history was significant for a total abdominal hysterectomy with bilateral salpingooophorectomy, performed eight years ago, for uterine fibroids and endometriosis. Workup revealed a mass measuring 5 × 4.5 × 2 cm in the rectosigmoid colon. Patient underwent a low anterior resection and a fungating, centrally ulcerated rectosigmoid mass with a positive mesorectal margin was removed. Histopathology revealed a heterologous mixed mesodermal tumor (chondroid and osteoid elements). The epithelial component was compatible with a grade 2 endometrioid adenocarcinoma. Immunohistochemical stains were supportive, with positive expression for CK7 and ER, negative for CK20, and only very focally and weakly positive for both CDX2 and p63. Chromogranin, synaptophysin, and TTF-1 were negative. Following surgery, she was treated with five cycles of carboplatin (AUC 6) and paclitaxel (175 mg/m2), followed by irradiation. Twenty-six months later, patient continues to be asymptomatic and disease-free. Mixed müllerian mesodermal tumors mimicking colorectal cancer have been reported in the past. Our case highlights the rarity and the challenges encountered in diagnosing and treating these rare tumors. Sakshi Kapur and Levin Miles Copyright © 2014 Sakshi Kapur and Levin Miles. All rights reserved. Sign of Leser-Trélat Associated with Esophageal Squamous Cell Cancer Thu, 06 Feb 2014 09:08:40 +0000 The sign of Leser-Trélat is a rare paraneoplastic phenomenon marked by accelerated onset of multiple seborrheic keratoses. The occurrence of the sign often points towards underlying visceral malignancies which in a majority are adenocarcinomas of the gastrointestinal tract. We report this case of a 65-year-old man who presented with sign of Leser-Trélat and was diagnosed with poorly differentiated squamous cell cancer of the esophagus. To our knowledge this is only the second such reported association of Leser-Trélat sign with squamous cell cancer of esophagus. Vinaya Gaduputi, Chaitanya Chandrala, Hassan Tariq, and Kalyan Kanneganti Copyright © 2014 Vinaya Gaduputi et al. All rights reserved. Fine-Needle Aspiration Cytology of Ewing’s Sarcoma of Thoracic Spine with Extension into the Intradural Space Mon, 03 Feb 2014 12:38:33 +0000 Ewing’s sarcoma/peripheral primitive neuroectodermal tumor is a small, round, and blue cell malignancy that occurs most often in bone and soft tissues of children and young adults. The intraspinal manifestation of the disease is rare, and when present, this is often misdiagnosed with other varieties of primary spinal tumors. Fine-needle aspiration cytology (FNAC) plays important role in the early diagnosis of these cases. We report such a case of Ewing’s sarcoma of thoracic spine with extension into the intradural space, which was initially suspected to be a case of metastatic lesion in an 18-year-old boy. Sandhya Bordia, Sweta Meena, Bijendar Kumar Meena, and Vijay Rajak Copyright © 2014 Sandhya Bordia et al. All rights reserved. Bisphosphonate-Related Osteonecrosis of the Jaw Mimicking Bone Metastasis Thu, 30 Jan 2014 11:10:50 +0000 Osteonecrosis of the jaw is usually a potential complication of bisphosphonate therapy. In a cancer patient, this disease entity can be misdiagnosed as a metastatic lesion. Our aim is to make clinicians aware of bisphosphonate associated osteonecrosis of the jaw to prevent misdiagnosis and initiate proper treatment at the earliest. We present the case of a breast cancer patient with multiple bony metastases and a jaw lesion presumed to be metastases. After no response to palliative radiation, repeat radiological imaging studies revealed osteonecrosis of the jaw. Correlating a patient’s clinical information with findings on diagnostic imaging studies, such as SPECT bone and CT scans, can help identify this potential complication of bisphosphonate treatment. Early diagnosis helps minimize unnecessary biopsies and allows for the proper treatment to be instituted. Geetika Bhatt, Aashish Bhatt, Anthony E. Dragun, Xiao-Feng Li, and A. Cahid Civelek Copyright © 2014 Geetika Bhatt et al. All rights reserved. Chemotherapy Improved Prognosis of Mesenchymal Chondrosarcoma with Rare Metastasis to the Pancreas Thu, 30 Jan 2014 08:48:46 +0000 Extraskeletal mesenchymal chondrosarcoma is rare and metastasis to the pancreas is extremely rare, with only four cases reported in the literature. The therapeutic effectiveness of chemotherapy remains uncertain. We report a 39-year-old man with extraskeletal mesenchymal chondrosarcoma of the buttock, who had metastases to the pancreas, bones, and lung. He underwent distal pancreatectomy, resection of the buttock tumor, and chemotherapy. He had a good response to chemotherapy and survived for about 3 years after surgery. Shinji Tsukamoto, Kanya Honoki, Akira Kido, Hiromasa Fujii, Yasunori Enomoto, Chiho Ohbayashi, and Yasuhito Tanaka Copyright © 2014 Shinji Tsukamoto et al. All rights reserved. Micromelanomas: A Review of Melanomas ≤2 mm and a Case Report Sun, 19 Jan 2014 10:49:48 +0000 The ABCD acronym used to screen pigmented lesions for melanoma obviously was not designed to contend with melanomas that are under 2 mm in diameter. Previously, views ranged that such small lesions could not be melanomas until a few reports of such “micromelanomas” emerged. The author presents a 2 mm melanoma in situ presenting as an insignificant pigmented lesion in a 60-year-old patient with no previous history of melanoma or multiple nevi—which is usually the norm in cases of small melanoma. This paper reiterates the fact that when it comes to a melanoma, size does not matter. In this paper, the term “micromelanoma” is used by the author to represent melanomas under 2 mm. Dermatoscopy and histopathology findings are discussed in this case, along with a review of small melanomas. Sharad P. Paul Copyright © 2014 Sharad P. Paul. All rights reserved.