Case Reports in Oncological Medicine http://www.hindawi.com The latest articles from Hindawi Publishing Corporation © 2016 , Hindawi Publishing Corporation . All rights reserved. A Novel Case of Penile Gangrene in a Patient Treated with Ibrutinib for Chronic Lymphocytic Leukemia Wed, 23 Nov 2016 14:20:03 +0000 http://www.hindawi.com/journals/crionm/2016/6980198/ Introduction. Ibrutinib is commonly used for the treatment of patients with CLL in either first-line or relapsed/refractory settings. Case Presentation. We present the case of a 74-year-old Caucasian man with CLL who presented with penile gangrene upon initiation of ibrutinib treatment. Our case is the first showing the complication of penile gangrene associated with ibrutinib use. The gangrene was self-limited upon discontinuing ibrutinib. Conclusion. Our finding describes a very rare yet important adverse event associated with ibrutinib use. William Paul Skelton IV, Neeka N. Akhavan, Zachary A. Taylor, Thu-Cuc Nguyen, Hassan Hassan, Tabitha N. Townsend, Prajwol Pathak, Gaurav Trikha, Nam H. Dang, Long H. Dang, and Azka Ali Copyright © 2016 William Paul Skelton IV et al. All rights reserved. Recurrence of Solid Pseudopapillary Tumor: A Rare Pancreatic Tumor Tue, 22 Nov 2016 14:08:15 +0000 http://www.hindawi.com/journals/crionm/2016/7523742/ Solid pseudopapillary tumor of the pancreas (SPTP) is a rare disease of young females that does not usually recur after resection. Here we report a case of an elderly female with history of SPTP ten years ago who presented with anorexia and a palpable left lower quadrant abdominal mass. Imaging revealed metastatic disease and US-guided biopsy of the liver confirmed the diagnosis of SPTP. Due to her advanced age and comorbidities, she elected to undergo hospice care. The objective of this case report is to increase awareness of this tumor and its possibility of recurrence, necessitating further guidelines for follow-up. Chandra Punch, Nupur Garg, and Penelope Harris Copyright © 2016 Chandra Punch et al. All rights reserved. Low Grade Lymphoma Mimicking Metastatic Urothelial Carcinoma: When Do We Need Further Histologic Staging? Tue, 22 Nov 2016 13:07:02 +0000 http://www.hindawi.com/journals/crionm/2016/8125898/ Introduction. Patients with urothelial carcinoma of the bladder often present with metastases to regional lymph nodes, with lymphadenopathy on physical examination or radiographic imaging. Case Presentation. We present the case of a 73-year-old Caucasian man with presumed metastatic urothelial carcinoma of the bladder to regional pelvic and retroperitoneal lymph nodes. He underwent systemic chemotherapy for treatment of urothelial carcinoma and was discovered on restaging to have findings suggestive of disease progression but ultimately was found to have a concurrent secondary malignancy. Conclusion. Our case suggests that in patients with urothelial carcinoma, the concurrent presentation of regional lymphadenopathy may not be metastatic urothelial carcinoma and may warrant further investigation. Azka Ali, William P. Skelton IV, Neeka N. Akhavan, Thu-Cuc Nguyen, Zachary A. Taylor, Tabitha Townsend, Prajwol Pathak, Nalini Hasija, Li Li, Jacqueline Indrisek, Scott Watson, Isis Nixon, Nam H. Dang, Robert Zlotecki, Paul Crispen, Robert Allan, Patricia Abbitt, and Long H. Dang Copyright © 2016 Azka Ali et al. All rights reserved. Primary Pericardial Sarcoma with Right Atrial Invasion and Multiple Bilateral Pulmonary Metastases in a Patient with Hereditary Nonpolyposis Colorectal Cancer Mon, 21 Nov 2016 09:16:49 +0000 http://www.hindawi.com/journals/crionm/2016/6208029/ Primary tumours originating from the pericardium are extremely rare. Previous studies have reported that these tumours account for only 6.7–12.8% of all mediastinal tumours with an overall prevalence of 0.001% to 0.007%. The majority of these tumours are benign lipomas or pericardial cysts. The most common pericardial malignancy is mesothelioma. Sarcomas are soft-tissue mesenchymal malignancies originating from various parts of the body but are extremely rare in this area. We report a case of a 52-year-old female who was diagnosed with a primary sarcoma with rhabdoid differentiation originating from the pericardium. The patient presented to her GP with a four-week history of progressive dyspnea and chest pain on exertion. Chest X-Ray demonstrated a prominent pericardial effusion and suspicious chest and pericardial lesions. Biopsies of the effusion and primary tumour identified on FDG/PET scans revealed the diagnosis of primary undifferentiated sarcoma. On thoracotomy, it was noted that the tumour had invaded the right atrium; therefore, pericardial window was aborted and a drain inserted instead. The patient was then started on chemotherapy; however, progression soon occurred and the patient died within 4 months, suggesting there is urgent need for efficacious treatments for sarcomatous lesions. Eugene Wong, Lawrence J. Oh, Kazi Nahar, Adrian Lee, and Stephen Clarke Copyright © 2016 Eugene Wong et al. All rights reserved. Corrigendum to “Diagnosis and Treatment of Mucinous Appendiceal Neoplasm Presented as Acute Appendicitis” Wed, 09 Nov 2016 11:03:03 +0000 http://www.hindawi.com/journals/crionm/2016/3612014/ Ioannis Kehagias, Apollon Zygomalas, Georgios Markopoulos, Thanasis Papandreou, and Pantelis Kraniotis Copyright © 2016 Ioannis Kehagias et al. All rights reserved. Chronic Lymphocytic Leukemia with Translocation (2;14)(p16;q32): A Case Report and Review of the Literature Thu, 03 Nov 2016 07:54:08 +0000 http://www.hindawi.com/journals/crionm/2016/9037436/ We report the case of a young African American male with no significant past medical history presenting with low back and bilateral leg pain; presenting CBC and chemistries revealed elevated white blood cell count of 250,000, with anemia (Hb 6.8 g/dL) and thrombocytopenia (platelets 9 K/μL), and elevated LDH, 1008. Physical examination findings were notable for diffuse lymphadenopathy and lower extremity skin nodules. Interestingly the bone marrow biopsy revealed involvement by CLL/SLL with translocation (2;14)(p16;q32) and trisomy 12. The patient was treated with fludarabine-based chemotherapy and steroids for CLL-related ITP with excellent response. After three cycles of chemotherapy, all the enlarged lymph nodes and skin nodules disappeared, and patient had achieved complete hematologic response. In this paper we also reviewed the available literature of CLL patients with translocation (2;14). Francisco Socola, Giovanni Insuasti-Beltran, Rodolfo Henrich Lobo, Shebli Atrash, and Appalanaidu Sasapu Copyright © 2016 Francisco Socola et al. All rights reserved. A Hormonally Active Malignant Struma Ovarii Wed, 02 Nov 2016 08:07:34 +0000 http://www.hindawi.com/journals/crionm/2016/2643470/ Struma ovarii is a rare monodermal variant of ovarian teratoma that contains at least 50% thyroid tissue. Less than 8% of struma ovarii cases present with clinical and biochemical evidence of thyrotoxicosis due to ectopic production of thyroid hormone and only 5% undergo malignant transformation into a papillary thyroid carcinoma. Only isolated cases of hormonally active papillary thyroid carcinoma developing within a struma ovarii have been reported in the literature. We report the case of a 36-year-old woman who presented with clinical signs and symptoms of hyperthyroidism as well as a left adnexal mass, which proved to be a thyroid hormone-producing, malignant struma ovarii. Carolina Lara, Dalia Cuenca, Latife Salame, Rafael Padilla-Longoria, and Moisés Mercado Copyright © 2016 Carolina Lara et al. All rights reserved. Primary Angiosarcoma of the Spleen: Rare Diagnosis with Atypical Clinical Course Thu, 27 Oct 2016 14:57:03 +0000 http://www.hindawi.com/journals/crionm/2016/4905726/ Primary angiosarcoma of the spleen is a rare diagnosis with poor prognosis. Morphologically, it demonstrates conventional blood vessel differentiation. We present a case of 65-year-old female who underwent radical splenectomy for primary angiosarcoma of the spleen. After three-year disease-free interval, she was diagnosed with bone-only metastatic disease. Palliative radiotherapy and bisphosphonates kept her disease reasonably stable for another four years. After development of lung metastases, six cycles of single agent doxorubicin kept her progression-free for six years. Upon further progression in lungs, thirteen years after original diagnosis, lung biopsy confirmed metastatic splenic angiosarcoma in the lungs. She started weekly paclitaxel chemotherapy. Although splenic angiosarcoma generally carries grave prognosis, some patients may enjoy prolonged periods of disease stabilization. Durable benefit can be achieved in some patients with multimodality management. We review the literature focusing on systemic treatment for this rare tumor. Filip Kohutek, Ladislav Badik, and Branislav Bystricky Copyright © 2016 Filip Kohutek et al. All rights reserved. Extramedullary Plasmacytoma Mimicking Pancreatic Cancer: An Unusual Presentation Tue, 25 Oct 2016 12:12:14 +0000 http://www.hindawi.com/journals/crionm/2016/6919210/ Multiple myeloma is a plasma cell tumor that homes to and expands in the bone marrow and that, despite the new available drugs, remains incurable. Extramedullary plasmacytoma is a not frequent manifestation during the natural history of multiple myeloma and is frequently associated with plasma cell bone marrow infiltration. The most common locations for an EMP include the gastrointestinal tract, pleura, testis, skin, peritoneum, liver, endocrine glands, and lymph nodes. Primary involvement of the gallbladder fossa is exceedingly rare. In this report, we describe a patient with multiple myeloma who achieved a clinical and serological remission after autologous transplant but progressed rapidly at extramedullary site mimicking a second cancer (i.e., pancreatic or biliary cancer). In this case, the extramedullary localization was refractory to standard therapy, differently from bone marrow localization, but responded to lymphoma-like therapy. In this patient (i) the particular site of developing plasmacytoma is the gallbladder fossa, (ii) the timing of onset of this neoplasm is immediately after autologous transplant, and (iii) its disjunction from primary myeloma is that it appears in clinical and serological remission phase which may be confounding during the diagnostic approach simulating a different tumor (solid tumor). Daniela Sciancalepore, Sergio Musci, Maria Rosaria Fracella, Grazia D’Alesio, Azzurra Sportelli, Giuseppe Ingravallo, Angelo Vacca, and Roberto Ria Copyright © 2016 Daniela Sciancalepore et al. All rights reserved. Effectiveness of Clavicula Pro Humero Reconstruction for Elderly Patients: Report of Two Cases Tue, 25 Oct 2016 11:37:15 +0000 http://www.hindawi.com/journals/crionm/2016/4140239/ Clavicula pro humero (CPH) reconstruction is a method that is used after proximal humeral excision. During CPH reconstruction, the ipsilateral clavicle is rotated downward and connected to the preserved distal humerus by using plates and screws. This method is frequently used for reconstruction surgeries involving young patients and has positive outcomes. In this study, we describe two cases of CPH reconstruction that were performed on elderly individuals after wide resection of the proximal humerus; postoperative results from these surgeries were satisfactory. The average Musculoskeletal Tumor Society (MSTS) functional score after surgery was 68.5%, indicating that CPH reconstruction is suitable for not only younger but also elderly patients, particularly those over the age of 65 years. Sho Okimatsu, Hiroto Kamoda, Tsukasa Yonemoto, Shintaro Iwata, and Takeshi Ishii Copyright © 2016 Sho Okimatsu et al. All rights reserved. Scrotal Involvement with Testicular Nonseminomatous Germ Cell Tumour Mon, 17 Oct 2016 13:38:16 +0000 http://www.hindawi.com/journals/crionm/2016/5471862/ A 37-year-old male presented with a traumatic injury to the scrotal region necessitating emergency surgery. Evacuation of a haematoma and bilateral orchidectomy were performed. A left sided nonseminomatous germ cell tumour (NSGCT), predominantly yolk sac, was identified. Microscopic margins were positive for tumour. Initial tumour markers revealed an AFP of 22,854 ng/mL, HCG of <1 mIU/mL, and LDH of 463 IU/L. Eight weeks after surgery, AFP levels remained elevated at 11,646 ng/mL. Computed tomography (CT) scanning demonstrated left inguinal adenopathy, 1.5 cm in max dimension. On review, extensive evidence of scrotal involvement was evident. His tumour was staged as stage IIIC, poor risk NSGCT. He was treated with 4 cycles of bleomycin, etoposide, and cisplatin over a 12-week period. His tumour markers normalised after 3 cycles. There was a marked improvement noted clinically. Follow-up CT scans demonstrated complete resolution of his tumour. He later underwent further surgery to remove a small amount of remaining spermatic cord. Histology revealed no malignant tissue. The patient suffered many complications including testosterone deficiency, osteopenia, infertility, and psychological distress. Discussion. A small proportion of testicular cancer may present in an atypical manner. The scrotum and testicle have markedly different embryonic origins and therefore a distinct anatomic separation. As a result the scrotum is not a typical site of spread of testicular cancer. Case reports have been described that were managed in a similar manner with good outcomes. Therefore, even with significant scrotal involvement, if timely and appropriate treatment is administered, complete resolution of the tumour may be achieved. C. G. O’Leary, J. A. Allen, F. O’Brien, A. Tuthill, and D. G. Power Copyright © 2016 C. G. O’Leary et al. All rights reserved. Scrotal Apocrine Adenocarcinoma with Pagetoid Phenomenon and Inguinal Lymph Node Metastases Wed, 12 Oct 2016 08:32:40 +0000 http://www.hindawi.com/journals/crionm/2016/8353745/ We report a case of scrotal apocrine adenocarcinoma in a 72-year-old Caucasian male which was initially presented as a reddish superficial lesion which in time became an ulcerated nodule. The initial pathological examination showed an apocrine adenocarcinoma with pagetoid phenomenon. The tumor recurred after four months and then excision biopsy showed tumor with pagetoid phenomenon which reached all the surgical margins. Three months later an ulcerated nodule in the scrotum and greatly enlarged ipsilateral inguinal lymph nodes were noticed. The final pathological examination showed multiple separated malignant foci, some with overlying pagetoid phenomenon and inguinal lymph node metastases. Immunohistochemistry showed positivity for Gross Cystic Disease Fluid Protein-15 (GCDFP-15), androgen receptors, and score 3+ for the Human Epidermal growth factor Receptor-2 (HER2). The aggressive behavior of the present tumor goes along with previous reports showing that HER2 high score cases exhibit a worse prognosis. Aristeidis Hristos Zibis, Apostolos Haralampos Fyllos, Sophia Havaki, Sotirios Sotiriou, Georgios Kotakidis, and Dimitrios Leonidas Arvanitis Copyright © 2016 Aristeidis Hristos Zibis et al. All rights reserved. Novel Brentuximab Vedotin Combination Therapies Show Promising Activity in Highly Refractory CD30+ Non-Hodgkin Lymphoma: A Case Series and Review of the Literature Tue, 11 Oct 2016 14:17:04 +0000 http://www.hindawi.com/journals/crionm/2016/2596423/ Non-Hodgkin lymphomas (NHLs) are a heterogeneous group of hematologic malignancies which typically respond to standard first-line chemoimmunotherapy regimens. Unfortunately, patients with refractory NHL face a poor prognosis and represent an unmet need for improved therapeutics. We present two cases of refractory CD30+ NHL who responded to novel brentuximab vedotin- (BV-) based regimens. The first is a patient with stage IV anaplastic large cell lymphoma (ALCL) with cranial nerve involvement who failed front-line treatment with cyclophosphamide, doxorubicin, vincristine, etoposide, and prednisone (CHOEP) and second line cyclophosphamide, vincristine, doxorubicin, dexamethasone alternating with high-dose methotrexate (MTX), and cytarabine (hyperCVAD) with intrathecal- (IT-) MTX and IT-cytarabine, but responded when BV was substituted for vincristine (hyperCBAD). The second patient was a man with stage IV diffuse large B-cell lymphoma (DLBCL) with leptomeningeal involvement whose disease progressed during first-line rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) and progressed despite salvage therapy with rituximab, dexamethasone, cytarabine, and cisplatin (R-DHAP) in whom addition of BV to topotecan resulted in a significant response. This report describes the first successful salvage treatments of highly aggressive, double refractory CD30+ NHL using two unreported BV-based chemoimmunotherapy regimens. Both regimens appear effective and have manageable toxicities. Further clinical trials assessing novel BV combinations are warranted. Wilfred Delacruz, Robert Setlik, Arash Hassantoufighi, Shyam Daya, Susannah Cooper, Dale Selby, and Alexander Brown Copyright © 2016 Wilfred Delacruz et al. All rights reserved. Single Jejunum Metastasis from Breast Cancer Arising Twelve Years after the Initial Treatment Mon, 03 Oct 2016 14:20:48 +0000 http://www.hindawi.com/journals/crionm/2016/8594652/ Metastatic involvement of gastrointestinal tract from breast cancer is a rare event. We report the case of a 61-year-old woman presenting with bowel obstruction, related to metastasis of a primary breast cancer she had 12 years earlier (a triple-negative invasive ductal carcinoma treated with surgery and chemotherapy). Bowel obstruction was caused by a 20-centimeter tumor in the jejunum, involving also the transverse colon. The patient underwent en bloc resection of tumor with jejunum and transverse bowel segment and received adjuvant chemotherapy with carboplatin and paclitaxel. Twenty months later, she was alive without disease recurrence. Cláudia Paiva, José Garcia, Cristina Silva, Alexandra Araújo, António Araújo, and Marisa D. Santos Copyright © 2016 Cláudia Paiva et al. All rights reserved. Poor Outcomes in Hepatic Amyloidosis: A Report of 2 Cases Wed, 28 Sep 2016 07:31:05 +0000 http://www.hindawi.com/journals/crionm/2016/7625940/ Hepatic amyloidosis is a rare disease entity that results from insoluble amyloid protein deposition in the liver. The disease often presents with vague, nonspecific clinical features. Currently, there is little literature describing treatment outcomes for biopsy-proven hepatic amyloidosis and current treatment guidelines recommend that patients enroll in a clinical trial due to insufficient evidence to suggest an optimal treatment regimen. Here, we present two cases of hepatic amyloidosis at an academic medical center and describe their presentation, treatment, and outcomes. These cases highlight the poor outcomes and difficult management of hepatic amyloidosis. Further understanding and investigation of this rare disease are warranted. Brandon Yim, Elizabeth Kertowidjojo, Yue Zhang, and Pruthvi Patel Copyright © 2016 Brandon Yim et al. All rights reserved. Refractory IgD Multiple Myeloma Treated with Daratumumab: A Case Report and Literature Review Mon, 26 Sep 2016 07:22:35 +0000 http://www.hindawi.com/journals/crionm/2016/2490168/ Patients with relapsed and refractory multiple myeloma have poor prognosis. A recent analysis of patients with relapsed and refractory multiple myeloma who were refractory to both proteasome inhibitors and immunomodulatory drugs showed the median overall survival of 9 months only. Daratumumab is the first-in-class human monoclonal antibody against CD38 cells which was studied in phase I/II trials for treatment of these patients with relapsed refractory multiple myeloma. It showed an overall response rate of 36% and a median overall survival (OS) of 17 months in these patients. We report a case of 40-year-old man with immunoglobulin D (IgD) multiple myeloma whose disease was refractory to at least 5 different chemotherapy regimens including proteasome inhibitors and immunomodulatory drugs. The clinical studies assessing daratumumab did not include any patients with IgD myeloma which is a rare form of multiple myeloma and to our knowledge is the first study reporting use of daratumumab in IgD myeloma. Muhammad Husnain, Sandra Kurtin, Nikki Barkett, Irbaz bin Riaz, and Amit Agarwal Copyright © 2016 Muhammad Husnain et al. All rights reserved. Smooth Muscle Tumor Originating in the Pleura: A Case Report and Updated Literature Review Thu, 22 Sep 2016 07:47:00 +0000 http://www.hindawi.com/journals/crionm/2016/9581395/ Smooth muscle tumors (SMTs) of the pleura are exceptionally rare. At present and to the best of these authors’ knowledge, there are only 17 cases reported in the literature. We describe a case of a 51-year-old woman who complained of left sided pleuritic chest pain. Further, computed tomography (CT) revealed a left sided localized pleural-based mass involving the 9th rib. She underwent an interventional radiology guided percutaneous core biopsy of the lesion, which disclosed a “Smooth Muscle Tumor of Undetermined Malignant Potential (SMT-UMP).” A video-assisted thoracoscopic surgery (VATS) was performed for diagnosis and treatment purposes. Resections of the pleural-based mass and 9th rib were performed. SMT-UMP was the definitive diagnosis. Santiago Fabián Moscoso Martínez, Vadim Zarubin, Geethapriya Rajasekaran Rathnakumar, and Alireza Zarineh Copyright © 2016 Santiago Fabián Moscoso Martínez et al. All rights reserved. Chemotherapy Used to Halt Lower GI Bleeding in a Rare Case of Metastatic Choriocarcinoma to the GI Tract Thu, 01 Sep 2016 08:38:26 +0000 http://www.hindawi.com/journals/crionm/2016/7620205/ Choriocarcinoma, a nonseminomatous germ cell tumor, is a rare type of testicular malignancy that tends to occur in young males. It is, however, exceedingly rare for choriocarcinoma to involve the GI tract. In this article, we present a rare case of a 31-year-old male, diagnosed with choriocarcinoma of the left testes, along with several metastases to distant sites. The patient presented with headaches and severe lower GI bleeding due to metastases to the GI tract, which was eventually controlled with systemic chemotherapy, while requiring several units of packed RBCs during his admission to the hospital. An extensive literature review found very few cases of the occurrence of GI bleeding as a consequence of choriocarcinoma due to metastases to the GI tract. Ralph Kamel, Talal Seoud, Teniola Oluwadamilola, Michael Karass, Emily Grossniklaus, Gabriela Oprea-Ilies, Daniel A. Goldstein, and Sanjay Jain Copyright © 2016 Ralph Kamel et al. All rights reserved. Cardiac Relapse of Acute Myeloid Leukemia after Allogeneic Hematopoietic Stem Cell Transplantation Tue, 23 Aug 2016 16:28:07 +0000 http://www.hindawi.com/journals/crionm/2016/5091021/ Secondary or metastatic cardiac tumors are much more common than primary benign or malignant cardiac tumors. Any tumor can cause myocardial or pericardial metastasis, although isolated or combined tumor invasion of the pericardium is more common. Types of neoplasia with the highest rates of cardiac or pericardial involvement are melanoma, lung cancer, and breast and mediastinal carcinomas. Acute myeloid leukemia (AML) is the most common type of acute leukemia in adults. Initial treatment involves chemotherapy followed by consolidation treatment to reduce the risk of relapse. In high-risk patients, the treatment of choice for consolidation is hematopoietic stem cell transplantation (HSCT). Relapse of AML is the most common cause of HSCT failure. Extramedullary relapse is rare. The organs most frequently affected, called “sanctuaries,” are the testes, ovaries, and central nervous system. We present a case with extramedullary relapse in the form of a solid cardiac mass. María Facenda-Lorenzo, Ana Sánchez-Quintana, Alejandro Quijada-Fumero, Ana Laynez-Carnicero, Joaquín Breña-Atienza, Francisco J. Poncela-Mireles, Juan M. Llanos-Gómez, Ana I. Cabello-Rodríguez, and María Ramos-López Copyright © 2016 María Facenda-Lorenzo et al. All rights reserved. A Case of Metastatic Adamantinoma That Responded Well to Sunitinib Wed, 17 Aug 2016 14:26:00 +0000 http://www.hindawi.com/journals/crionm/2016/5982313/ Adamantinoma is a rare low-grade malignant bone tumor of epithelial origin. Metastatic adamantinoma has been reported to be resistant to chemotherapy. We report a case of metastatic adamantinoma to the lung, 10 years after the initial diagnosis of tibial mass. The patient received radiation therapy to the lung with partial response. A surveillance PET scan revealed progression of the lung mass and biopsy confirmed to be progressive residual metastatic adamantinoma. He received carboplatin and etoposide for 7 months and achieved a partial response. Four months later, PET scan showed disease progression. We started him on sunitinib, a multikinase inhibitor. He achieved a good partial response for 3 years. He died due to pneumonia at the age of 72. Andrew D. Liman, Agnes K. Liman, Jenna Shields, Becky Englert, and Rashmikant Shah Copyright © 2016 Andrew D. Liman et al. All rights reserved. Spontaneous Rupture of Hepatic Metastasis from Pancreatic Adenocarcinoma Mon, 15 Aug 2016 08:43:37 +0000 http://www.hindawi.com/journals/crionm/2016/6968534/ A 58-year-old man with advanced-stage pancreatic adenocarcinoma presented with fatigue and dyspnea. Examination revealed tachycardia (102 b/min) with mild tenderness in right upper quadrant. His hemoglobin (Hb) was 7.9 g/dL (10 days prior to presentation 12.2 g/dL), International normalized ratio (INR), platelet count was normal, and the stool guaiac test was negative. On admission, abdominal computed tomography (CT) scan showed hepatic metastatic lesion with a rupture and hemoperitoneum communicating to the subdiaphragmatic space. This rapid progression of anemia along with presenting symptoms and CT imaging were attributed to diagnosis of spontaneous rupture of liver metastasis from pancreatic adenocarcinoma. Patient received blood transfusion and hemoglobin was monitored in successive intervals. His general condition and anemia improved with conservative management and he was discharged in 3 days. Repeated CT after 4 months showed resolving hemoperitoneum and stable hemoglobin levels. The patient deceased 9 months after being diagnosed. A literature search revealed limited data regarding the incidence and management of spontaneous rupture of metastatic lesion secondary to pancreatic adenocarcinoma which has been managed conservatively and thus we are reporting our experience. Anil Rahul, Fernandes Robin, and Hiremath Adarsh Copyright © 2016 Anil Rahul et al. All rights reserved. Cutaneous Metastases of the Synchronous Primary Endometrial and Bilateral Ovarian Cancer: An Infrequent Presentation and Literature Review Thu, 11 Aug 2016 11:01:34 +0000 http://www.hindawi.com/journals/crionm/2016/4568653/ There are limited data about the cutaneous metastases of gynecological malignancies in the literature. Based on this limited number of studies, cutaneous metastases from gynecological malignancies are uncommon occurrences. Cutaneous metastases from the synchronous endometrioid carcinoma of the uterine corpus and bilateral ovaries arising from endometriosis are extremely rare. Herein, we report a 51-year-old woman with FIGO Stage 1A Grade 1 endometrial endometrioid-type adenocarcinoma and synchronous bilateral Stage 1B ovarian endometrioid-type adenocarcinoma who presented 34 months following total abdominal hysterectomy and bilateral salpingo-oophorectomy with skin metastases. After the patient underwent an excisional biopsy, we applied a palliative radiotherapy. The patient received the combination therapy with cisplatin and doxorubicin after the completion of radiotherapy but the disease evolution was rapidly fatal and the patient died 4 months after her admission to our department due to widely disseminated disease. Gul Kanyilmaz, Meryem Aktan, Mehmet Koc, and Siddika Findik Copyright © 2016 Gul Kanyilmaz et al. All rights reserved. Pancreatic GIST in a Patient with Limited Stage Small Cell Lung Cancer: A Case Report and Review of Published Cases Mon, 08 Aug 2016 09:14:40 +0000 http://www.hindawi.com/journals/crionm/2016/9604982/ Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal tract and usually occur in the stomach and the small intestine. The pancreas is an extremely rare primary site for GISTs and there are 25 reported cases of pancreatic GIST with most being treated with surgical resection. We describe a 52-year-old African-American female who was diagnosed with limited stage small cell carcinoma in November 2009 and treated with concurrent cisplatin/etoposide chemotherapy and radiation. She subsequently achieved complete remission. Two years later she was diagnosed with localized pancreatic GIST by endoscopic ultrasonography guided fine needle aspiration. We treated her with a tyrosine kinase inhibitor (TKI) imatinib 400 mg oral dose daily as she declined surgery. Her disease is stable based on computed tomography imaging scans 40 months after diagnosis without any metastasis. To the best of our knowledge, our case is the second case of localized pancreatic GIST treated with TKI monotherapy. Minh Phan, Shari Jones, Justin Jenkins, Shubham Pant, and Mohamad Khawandanah Copyright © 2016 Minh Phan et al. All rights reserved. Gastric Medullary Carcinoma: A Rare Case Report Wed, 03 Aug 2016 13:50:22 +0000 http://www.hindawi.com/journals/crionm/2016/2875471/ A case of 64-year-old female patient with early stage gastric medullary carcinoma has been presented, along with a review of the literature. Ferit Aslan, Fisun Ardıç Yükrük, Fatma Buğdaycı Başal, and Ayşe Durnalı Copyright © 2016 Ferit Aslan et al. All rights reserved. An Extremely Rare Case of Advanced Metastatic Small Cell Neuroendocrine Carcinoma of Sinonasal Tract Wed, 27 Jul 2016 09:00:55 +0000 http://www.hindawi.com/journals/crionm/2016/1496916/ Small cell neuroendocrine carcinoma (SNEC) is a rare form of malignancy. It mainly presents as bronchogenic neoplasm, and the extrapulmonary form accounts for only 0.1% to 0.4% of all cancers. These extrapulmonary tumors have been described most frequently in the urinary bladder, prostate, esophagus, stomach, colon and rectum, gall bladder, head and neck, cervix, and skin. Primary SNEC of the sinonasal tract is extremely rare with only less than 100 cases reported in the literature. Because of extreme rarity and aggressiveness of the tumor, the management for this entity varies considerably mandating multimodality approach. In this paper, we report a patient presented with left-sided facial swelling, and the histopathologic examination confirmed primary SNEC of left sinonasal tract. The tumor involved multiple paranasal sinuses with invasion into the left orbit and left infratemporal fossa and metastasized to cervical lymph nodes and bone. The patient encountered devastating outcome in spite of optimal medical management and treatment with palliative chemotherapy highlighting the necessity for further research of primary SNEC of head and neck. Yu Yu Thar, Poras Patel, Tiangui Huang, and Elizabeth Guevara Copyright © 2016 Yu Yu Thar et al. All rights reserved. Myofibroblastoma of the Breast: Literature Review and Case Report Mon, 25 Jul 2016 10:15:32 +0000 http://www.hindawi.com/journals/crionm/2016/1714382/ Myofibroblastoma of the breast is a rare benign spindle cell tumor. The main aim of this study is to review the literature of this rare tumor. We present a case of a mammary myofibroblastoma occurring in an 82-year-old man, emphasizing the clinical, radiological, and pathological features. The tumor was successfully identified and managed in our hospital. We would like to draw the attention of clinicians to myofibroblastoma as a rare possibility in the differential diagnosis of a breast mass. Mario Metry, Mohamad Shaaban, Magdi Youssef, and Michael Carr Copyright © 2016 Mario Metry et al. All rights reserved. A Case of Undiagnosed HIV Infection in a 57-Year-Old Woman with Multiple Myeloma: Consequences on Chemotherapy Efficiency and Safety Wed, 20 Jul 2016 08:57:37 +0000 http://www.hindawi.com/journals/crionm/2016/8515218/ Background. Non-AIDS-defining cancers represent a rising health issue among HIV-infected patients. Nevertheless, HIV testing is not systematic during the initial cancer staging. Here, we report a case of HIV infection diagnosed three years after chemotherapy initiation for multiple myeloma. Results. A 57-year-old woman diagnosed with multiple myeloma underwent a first round of chemotherapy by bortezomib/lenalidomide and then with bortezomib/liposomal-doxorubicine/dexamethasone, with partial remission, poor hematological tolerance, and multiple episodes of pneumococcal infection. Allogenic stem cell transplantation was proposed leading to HIV testing, which revealed seropositivity, with an HIV viral load of and severe CD4 T cell depletion (24 cells/mm3). Chemotherapy by bendamustin was initiated. Multidisciplinary staff decided the initiation of antiretroviral therapy with tenofovir/emtricitabin/efavirenz and prophylaxis against opportunistic infections. After 34 months, patient achieved complete remission, sustained HIV suppression, and significant CD4 recovery (450 cells/mm3), allowing effective pneumococcal immunization without relapse. Conclusion. Our case illustrates the drawback that ignored HIV infection is still causing to cancer patients receiving chemotherapy and highlights the importance of early HIV testing in oncology. A multidisciplinary approach including oncologists/hematologists, virologists, and pharmacists is recommended in order to avoid drug interactions between chemotherapy and antiretroviral drugs. Moreover, prophylactic medication is recommended in these patients regardless of CD4+ cell count at the initiation of chemotherapy. I. Poizot-Martin, S. Brégigeon, C. Tamalet, R. Bouabdallah, O. Zaegel-Faucher, V. Obry-Roguet, A. Ivanova, C.E. Cano, and C. Solas Copyright © 2016 I. Poizot-Martin et al. All rights reserved. West Nile Virus Encephalitis in a Patient with Neuroendocrine Carcinoma Tue, 19 Jul 2016 12:59:06 +0000 http://www.hindawi.com/journals/crionm/2016/9497075/ Importance. Oftentimes, when patients with metastatic cancer present with acute encephalopathy, it is suspected to be secondary to their underlying malignancy. However, there are multiple causes of delirium such as central nervous system (CNS) infections, electrolyte abnormalities, and drug adverse reactions. Because West Nile Virus (WNV) neuroinvasive disease has a high mortality rate in immunosuppressed patients, a high index of suspicion is required in patients who present with fever, altered mental status, and other neurological symptoms. Observations. Our case report details a single patient with brain metastases who presented with unexplained fever, encephalopathy, and new-onset tremors. Initially, it was assumed that his symptoms were due to his underlying malignancy or seizures. However, because his unexplained fevers persisted, lumbar puncture was pursued. Cerebrospinal fluid analysis included WNV polymerase chain reaction and serologies were ordered which eventually led to diagnosis of WNV encephalitis. Conclusions and Relevance. Patients with metastatic cancer who present with encephalopathy are often evaluated with assumption that malignancy is the underlying etiology. This can lead to delays in diagnosis and possible mistreatment. Our case highlights the importance of maintaining a broad differential diagnosis and an important diagnostic consideration of WNV encephalitis in patients with cancer. Romina Deldar, Derek Thomas, and Anna Maria Storniolo Copyright © 2016 Romina Deldar et al. All rights reserved. Testicular Signet-Ring Cell Metastasis from a Carcinoma of Unknown Primary Site: A Case Report and Literature Review Mon, 18 Jul 2016 12:52:15 +0000 http://www.hindawi.com/journals/crionm/2016/7010173/ Signet-ring cell carcinoma is a highly malignant adenocarcinoma consisting of cells characterized as cytoplasmic vacuoles filled with mucin. The most common primary location of this type of cancer is the stomach, but it may also be found in other organs such as prostate, testis, bladder, ovaries, or colon. To date, metastatic signet-ring cell carcinoma of unknown primary (CUP) site to the testis is an extremely rare entity in daily practice. Reviewing the literature, we have been able to detect only three cases of testicular metastases from CUP, two with histological diagnosis of a signet-ring cell carcinoma and one with an adenocarcinoma. In this short paper, we report a case of a 56-year-old man who presented to our Department with testicular mass and ascites. Following a standard diagnostic approach no primary tumor could be identified. CUP was the final clinical diagnosis, histologically characterized as poorly differentiated adenocarcinoma with signet-ring cells involving the peritoneum and the testicular structures. Aristomenes Kollas, George Zarkavelis, Anna Goussia, Aikaterini Kafantari, Anna Batistatou, Zoi Evangelou, Eva Sintou, and Nicholas Pavlidis Copyright © 2016 Aristomenes Kollas et al. All rights reserved. Metastatic Breast Carcinoma to the Prostate Gland Sun, 26 Jun 2016 12:13:02 +0000 http://www.hindawi.com/journals/crionm/2016/8264140/ Cancer of the male breast is an uncommon event with metastases to the breast occurring even less frequently. Prostate carcinoma has been reported as the most frequent primary to metastasize to the breast; however, the reverse has not been previously reported. Herein, we present, for the first time, a case of breast carcinoma metastasizing to the prostate gland. Prostate needle core biopsy revealed infiltrative nests of neoplastic epithelioid cells, demonstrated by immunohistochemistry (IHC) to be positive for GATA3 and ER and negative for PSA and P501S. A prostate cocktail by IHC study demonstrated lack of basal cells (p63 and CK903) and no expression of P501S. The patient’s previous breast needle core biopsy showed strong ER positivity and negative staining for PR and HER2. Similar to the prostate, the breast was negative for CK5/6, p63, and p40. This case demonstrates the importance of considering a broad differential diagnosis and comparing histology and IHC to prior known malignancies in the setting of atypical presentation or rare tumors. Meghan E. Kapp, Giovanna A. Giannico, and Mohamed Mokhtar Desouki Copyright © 2016 Meghan E. Kapp et al. All rights reserved.