Neurolymphomatosis: a rare metastatic complication of diffuse large B-Cell lymphoma

To report the occurrence of neurolymphomatosis in a patient with previously treated systemic diffuse B-cell lymphoma (DLBCL). A case report. University medical center. A 54-year old woman with previously treated DLBCL developed sequential mono-, di- and triparesis 3-months after completion of systemic therapy. MR of lumbar and brachial plexus revealed diffuse involvement of nerve roots and plexus. High-dose methotrexate and involved-field radiotherapy. Neurolymphomatosis, although rare, is increasingly recognized with peripheral and central nervous system MRI. Treatment remains unsatisfactory as treatment with methotrexate-based chemotherapy and irradiation is only partially effective.     

Tandem tip fracture: a rare complication of intracavitary therapy of cervix cancer and how to avoid its occurrence

A case is described in which the distal tip of a tandem fractured off in a patient's uterus during an intracavitary application of a tandem and ovoids. Potential contributing factors are evaluated. Methods to prevent and detect structural defects in tandems before they become clinically manifest are discussed.     

Bouveret's syndrome: A rare complication of cholecystolithiasis

Bouveret's syndrome is obstruction of the stomach or the duodenum from a gallstone that has migrated through a biliogastric or bilioduodenal fistula. This rare syndrome has been described in a number of case reports     

The genetics of gestational trophoblastic disease: a rare complication of pregnancy

Gestational choriocarcinoma is usually a rapidly spreading fatal disease, but it is curable if diagnosed early and treated. It is a unique malignancy that is a partial or complete allograft with a genotype that is not the same as the host genotype. It is most often preceded by an abnormal molar pregnancy. The surprising and unique androgenetic origin of complete hydatidiform molar pregnancies was first revealed by Kajii and Ohama in 1977. We describe the current understanding of the morphology, epidemiology and genetics of gestational trophoblastic disease that followed the milestone findings by Kajii and Ohama.     

Choanal stenosis: a rare complication of radiotherapy for nasopharyngeal carcinoma]

Choanal stenosis is usually a congenital anomaly in children. Acquired choanal stenosis after radiotherapy for nasopharyngeal carcinoma is a very rare pathology; only two publications report seven cases in the literature. We describe the clinical history, preoperative evaluation, surgical treatment and outcome of a case of acquired choanal stenosis after radiotherapy. The patient, a 56-year-old woman, presented with a history of nasopharyngeal carcinoma (T2- NO-MO) one year before that had been successful treated with radiotherapy (68 Gy). At the end of radiotherapy, she complained of complete nasal obstruction, anosmia and hearing loss due to a bilateral serous otitis media. Bilateral complete choanal stenosis was confirmed by endoscopy and CT scan. Functional endoscopic surgery was performed, and nasal stents were left in place for 3 weeks. One year after, the patient have good airflow, and a patent nasopharynx without choanal stenosis. In conclusion, choanal stenosis is an unusual complication of radiotherapy that can be successfully treated with transnasal endoscopic resection.     

Catheter fracture and cardiac migration: a rare complication of totally implantable venous devices

Totally implantable venous device (TIVD) are widely used for the treatment of patients requiring long-term chemotherapy, total parenteral nutrition and fluid replacement. Until today, many kinds of complications have been reported in the literature. We report an unusual case of catheter fracture as a consequence of pinchoff syndrome, and discuss the potential methods to avoid this complication and its evolution.     

Acute leukaemia during tamoxifen therapy

Tamoxifen treatment is a proven therapy for breast cancer that produces a survival advantage when used as an adjuvant, and reduces the incidence of recurrences and controlateral tumor evolution. Although this therapy has a very low toxicity profile, an increase in secondary cancers has been reported. Tamoxifen is suggested to be carinogenic both through direct genotoxic and epigenetic mechanisms. It is activated by cytochrome P450 to form reactive metabolites that bind covalently to DNA to create adducts. We report two cases that developed acute myeloid leukaemia (AML) during tamoxifen therapy for breast cancer.     

Uterine cervical metastasis of breast cancer: a rare complication that may be overlooked

BACKGROUND: Metastasis of distant malignancies to the cervix uteri is a rare occurrence and the frequency is approximately 4% for all tumours. However, the frequency of cervical metastasis of breast cancer is much lower and is estimated to range between 0.8 and 1.7%. With the exception of ovarian metastases, secondary tumours of the female genital tract are rather uncommon. Therefore, these conditions pose diagnostic problems for the clinician. PATIENT: A 40-year-old woman with the diagnosis of invasive ductal cell carcinoma of the right breast underwent mastectomy with dissection of axillary lymph nodes in 1998. Subsequently, the patient received 6 cycles of chemotherapy with cyclophosphamide, methotrexate and fluorouracil. The initial tumour stage was pT2, pN0 (0/13), M0, G2. The oestrogen and progesterone receptors were positive and expression of the C-erb-B2 coding oncogene was negative. Gynaecological and ultrasonographic examination revealed a normal cervix without evident lesions. Exfoliative cytology was negative. 14 months after treatment the patient presented with an axillary relapse and surgery, second-line chemotherapy with doxorubicine and radiation therapy of the chest wall and the axilla were performed. The patient developed liver metastases 14 months later and at this time ultrasonographic pelvic examination revealed a 2.2 cm tumour of the cervix with good vascularisation. The patient had no clinical symptoms, i.e. no vaginal bleeding or discharge. Sonomorphologically this tumour appeared as a leiomyoma of the cervix. Cervical biopsies and curettage, however, revealed metastatic carcinoma expressing oestrogen and progesterone receptors consistent with the primary breast cancer. Under palliative chemotherapy with docetaxel progression of liver metastases and cervical metastasis occurred and the patient died 9 months later. CONCLUSION: Metastatic involvement of the cervix should be considered in women with a history of breast cancer who present with vaginal bleeding or suspicious changes of the cervix on transvaginal ultrasound. Therefore, gynaecological and ultrasonographic examination of the pelvis represent an important part of the follow- up investigations in women with primary breast cancer.     

Duration of adjuvant tamoxifen therapy.

The benefit of using adjuvant tamoxifen to treat breast cancer has been firmly established for patients with estrogen receptor (ER)-positive tumors, regardless of age, lymph node status, or menopausal status. Uncertainty remains, however, regarding the optimal duration of tamoxifen therapy. We reviewed the findings of randomized clinical trials that directly compared alternative treatment durations. Trials comparing short-term adjuvant treatment with tamoxifen (i.e., 1-3 years) with treatments having durations of about 5 years consistently have demonstrated additional benefits stemming from the longer therapy. Trials testing 5 years of treatment with longer durations have, in the aggregate, suggested no additional benefit for the patient. Nevertheless, the number of recurrences reported to date in these trials is not large, and the results of the individual trials are heterogeneous. Furthermore, as a result of tamoxifen's "carryover" effect, duration trials require considerable follow-up before definitive results can be established. Until more definitive data become available, adjuvant treatment with tamoxifen should be limited to 5 years outside the clinical trials setting. Continued accrual of ER-positive patients to ongoing tamoxifen duration trials, including the Adjuvant Tamoxifen Treatment Offer More (aTTom) and Adjuvant Tamoxifen Longer Against Shorter (ATLAS) trials, is appropriate. Alternatively, patients who remain disease free after 5 years of tamoxifen therapy should be encouraged to participate in trials testing crossover to other hormonal interventions, including selective ER modulators or aromatase inhibitors.     

Invasive pulmonary aspergillosis: A rare complication after microwave ablation

Three cases are reported of invasive pulmonary aspergillosis (IPA) occurring after microwave ablation (MWA) for lung tumours. This is a rare complication that has not previously been described in the literature. The diagnosis of IPA was based on the following factors: host factors, clinical manifestations and mycological findings. The first case was a 63-year-old man treated for primary lung squamous carcinoma. Significant tumour regression was achieved by 18 days after MWA, medical treatment with itraconazole for 6 weeks, and postural drainage. The second case, a 65-year-old man, was confirmed with primary lung squamous cell carcinoma. Voriconazole administration using intravenous infusion combined with intracavitary lavage was therapeutically effective after MWA at 1 year follow-up. The third case was a 61-year-old woman with primary lung adenocarcinoma. Delayed pneumothorax and bronchopleural fistula secondary to IPA persisted. The patient died from secondary multiple organ function failure. Despite its very low incidence, the significance of early diagnosis and early administration of antifungal therapy should be highlighted because of the relentless severity of IPA in patients undergoing MWA.     

Arena: Overprolonged adjuvant tamoxifen therapy in breast cancer

While adjuvant tamoxifen therapy given continuously for 2–3years can lead to a modest improvement in survival rates inearly breast cancer, there is no evidence that prolonging tamoxifenadministration beyond that time is likely to improve survivalrates any further in unselected cases. In the case of advanceddisease, an alternating tamoxifen/progestagen regimen has beenshown to increase the response rate and also its duration, beyondthat to be expected from either agent alone. The next generationof adjuvant trials in breast cancer needs to explore the potentialof an alternating tamoxifen/megestrol regimen. breast cancer, tamoxifen therapy, progestagen therapy, megestrol therapy, adjuvant therapy     

乳腺癌患者应用三苯氧胺导致的妇科并发症及其监测

三苯氧胺具有抗雌激素和雌激素的双重特性,长期持续使用可导致子宫内膜发生多种病理改变。临床应予以重视,并加以监测。本文就妇科并发症的发生和临床监测方面做一综述,以早发现、并减少并发症的发生。     

Renal fungus ball in a patient with retroperitoneal fibrosis: Unique complication in a rare disease

Candida fungus ball is a rare presentation of urinary tract infections among adult patients and is associated with considerable morbidity. Because clinical signs are not specific, diagnosis is often delayed. Furthermore, treatment is occasionally difficult, and the approach to such cases varies widely among different centers. In this report, we describe a patient with retroperitoneal fibrosis who developed a renal fungus ball. Management of this challenging case is discussed, and review of the literature is presented.     

Blurring of vision: a previously undescribed complication of cyclophosphamide therapy.

Five children with cancer treated with high dose cyclophosphamide experienced blurring of vision. In three patients, the blurring lasted less than one hour and disappeared, abruptly, but in the other two, it was prolonged, lasting three and 14 days with gradual improvement. In all five complete restoration of normal vision occurred. We have not found other reports of this association in the literature.     

Acute leukemia,a rare but fatal complication after liver transplantation

Little information is available about the risk factors and means to improve the survival rate of acute leukemia in a rare but often fatal complication after liver transplantation (LT). We report the development of AML-M2 in one of the 764 patients who underwent liver transplantation at our center, and review the literature on similar cases. The patient, a 42-year-old man who developed acute leukemia 38 months after liver transplantation, was successfully treated with chemotherapy and has subsequently been in remission. With appropriate adjustment of immunosuppressive agents, he was able to safely benefit from chemotherapy. Only 16 patients with acute leukemia after liver transplantation have been reported, and the mortality rate is extraordinarily high (52.94%, 9/17). More cases of acute leukemia will emerge as the rate of survival after liver transplantation increases. The patient's chromosomal mutation profile, the choice of immunosuppressive agent, and infection by hepatitis virus may be the risk factors for the development of acute leukemia after LT. Our experience suggests that clinicians should adjust the immunosuppressive agents according to the immunosuppressive state of the patient and explore the option of reducing or stopping the medication as long as liver function remains stable. These measures could help reduce the high mortality rate among these patients.