Purpose Prostate cancer is a heterogeneous disease with variable clinical outcomes. Despite numerous recent approvals of novel therapies, castration-resistant prostate cancer remains lethal. A “real-world” clinical-genomic database is urgently needed to enhance our characterization of advanced prostate cancer and further enable precision oncology. Methods The Prostate Cancer Precision Medicine Multi-Institutional Collaborative Effort (PROMISE) is a consortium whose aims are to establish a repository of de-identified clinical and genomic patient data that are linked to patient outcomes. The consortium structure includes a (1) bio-informatics committee to standardize genomic data and provide quality control, (2) biostatistics committee to independently perform statistical analyses, (3) executive committee to review and select proposals of relevant questions for the consortium to address, (4) diversity/inclusion committee to address important clinical questions pertaining to racial disparities, and (5) patient advocacy committee to understand patient perspectives to improve patients’ quality of care. Results The PROMISE consortium was formed by 16 academic institutions in early 2020 and a secure RedCap database was created. The first patient record was entered into the database in April 2020 and over 1000 records have been entered as of early 2021. Data entry is proceeding as planned with the goal to have over 2500 patient records by the end of 2021. Conclusions The PROMISE consortium provides a powerful clinical-genomic platform to interrogate and address data gaps that have arisen with increased genomic testing in the clinical management of prostate cancer. The dataset incorporates data from patient populations that are often underrepresented in clinical trials, generates new hypotheses to direct further research, and addresses important clinical questions that are otherwise difficult to investigate in prospective studies.
Background: Colorectal cancer (CRC) is the second most common cause of cancer related deaths in the United States. Colonoscopy is the gold standard for the detection of CRC. There are many colonoscopy quality measures and among these the adenoma detection rate (ADR) has demonstrated a significant impact in reducing mortality from CRC. The primary aim of our study was to compare ADR and distribution of polyp type in patients undergoing Endocuff-assisted colonoscopy (EAC) versus standard colonoscopy (SC) in a VA system. Methods: Retrospective data was collected from 496 patients who underwent routine screening, surveillance and diagnostic colonoscopies either via SC from January 6, 2014 through March 12, 2014 or EAC from September 24, 2014 through February 19, 2015. A total of 54 patients were excluded based on a personal history of CRC and prior resection, incomplete colonoscopy due to poor bowel preparation, and removal or loss of Endocuff (EC). Primary outcomes measured and compared were ADR and types of polyps found. Results: The overall ADR in the EAC group was higher at 59.91% versus 50.66% for SC, accounting for a 9% increase (P=0.0508). EAC was able to detect a total of 59 sessile serrated adenoma/polyps (SSA/Ps) compared to SC only detecting 8 (P≤0.0001). There was a significant increase in the SSA/P detection rate with EAC at 15% versus 3% in the SC group (P≤0.0001). Conclusions: EAC significantly increases the detection of SSA/P and has shown a trend in improving ADR in our veteran population.
Cryptococcal meningitis is a life-threatening condition most commonly observed in immunocompromised individuals. We describe a daily cannabis smoker without evidence of immunodeficiency presenting with confirmed meningitis. An investigation of cannabis samples from the patient's preferred dispensary demonstrated contamination with several varieties of, including , and other opportunistic fungi. These findings raise concern regarding the safety of dispensary-grade cannabis, even in immunocompetent users.
Primary signet ring-cell carcinoma of the lung (SRCC) is an extraordinary rare clinical event and very few cases of pure SRCC have been described. 1 SRCC is a recognized variant of pulmonary adenocarcinoma in the WHO classification 2 and has been known to have a distinct clinical-pathological presentation. 3 These tumors are known to be highly aggressive and patients typically have a worse prognosis than other lung tumor types. 4 We describe a rare and unusual case of signet ring-cell carcinoma of the lung in which cytomorphological features of signet ring-cells were studied in bronchial lavage and brush specimens as well in corresponding bronchial biopsy from primary lung tumor. This is the first case of cytomorphology of SRCC from the actual lung primary with confirmatory bronchial biopsy, which is important to recognize because of its bland cytologic features and resemblance to alveolar macrophages that may lead to an erroneous cytologic diagnosis. Case ReportA 55-year-old female presented with weight loss, headache, nausea, vomiting, and persistent cough. The cough had been persistent for months, however the headache had increased over the recent weeks, and was then followed by the nausea and vomiting. No hemoptysis, seizures, or neurologic deficits were reported. Chest radiograph showed complete opacification of the right upper lobe. Subsequent chest CT scan revealed an 8.6 cm right upper lobe lung mass which occluded the right upper lobe bronchus and encased the right upper lobe pulmonary artery segment. Mediastinal lymphadenopathy was present as well as multiple hypodensities within the liver suspi-cious for metastasis. CT and MRI of the brain revealed a likely metastatic lesion involving the right parietal occipital area. A plain film of the leg was performed because the patient complained of intermittent pain which showed a permeative lesion in the mid shaft of the tibia suspicious for metastasis. PET scan showed increased uptake in the right upper lobe of lung consistent with carcinoma with increased uptake in the mediastinum consistent with metastatic involvement of mediastinal lymph nodes.Bronchoscopy was performed and bronchial lavage and brushings were transferred to glass slides and were fixed in 95% alcohol and stained with Papanicolaou stain. However, the bronchoscopic biopsy specimen was fixed in formaldehyde and embedded in paraffin. Histologic sections were stained with conventional hematoxylin and eosin stain, and mucicarmine stain. Immunoperoxidase stains for Cytokeratin 7 (Dako, diluted 1:400), and thyroid transcription factor 1 (Dako R kits, clone 8G7G3/1, diluted 1:200) were performed with avidin-biotin-complex and diaminobenzidine as a substrate, to further characterize this tumor.
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