BackgroundNeurological paraneoplastic syndromes are rarely the first manifestation of an underlying cancer. A high index of suspicion is thus needed to diagnose such conditions. Paraneoplastic limbic encephalitis is one such entity which is well described in association with small cell lung cancers, testicular germ cell tumors, breast cancers and ovarian tumors. This article describes the entity being associated with an ovarian tumor.CaseA 36-year-old female presented with abnormal behaviour, mood swings and delusions. She was evaluated for her psychiatric symptoms and found to have an underlying ovarian tumor. Anti-NMDA receptor titers were strongly positive. She underwent oophorectomy, and post-operatively there was a significant improvement in her psychiatric symptoms.ConclusionsOvarian tumors like teratomas are implicated in the pathogenesis of paraneoplastic limbic encephalitis. An underlying ovarian tumor must be evaluated in all young females presenting with sudden onset of psychiatric symptoms.
This article presents an unusual isolated metastasis to nasopharynx from HCC in the absence of disseminated disease. This case report illustrates the distinctive pathological features of metastatic HCC.
Introduction: Thyroid nodules are common clinical entity. Though indolent in nature, they can be invasive too. However, tracheal tumours are relatively rare and come into clinical picture when patients show symptoms of tracheal obstruction. Case report:We report a 45 year old female who presented with cytology proven papillary carcinoma thyroid with clinical and radiological evidence of tracheal involvement. Patient underwent total thyroidectomy along with en bloc segmental tracheal resection with end to end anastomosis. However the pathology revealed adenoid cystic carcinoma of trachea. Conclusion:Adenoid cystic carcinomas of trachea are rare tumors and they can present as thyromegaly secondary to thyroid involvement. Surgeons should have a high index of suspicion for diagnosis. Surgical resection forms the mainstay of treatment.
Background: Recommended chemotherapy for unresectable locally advanced or metastatic non-small cell lung cancer (NSCLC) includes platinum agents, taxanes and immunotherapy agents. However, these treatments have been associated with the development of peripheral neuropathy (PN). We present the incidence rates of PN and identify its predictors using a real-world data source. Method: In Optum's Humedica electronic health records database, we identified NSCLC patients diagnosed between 1/1/2008 and 12/31/2017, using a combination of ICD-9/ICD-10 diagnosis codes and structured data derived from physician notes. Patients with lung surgery or other primary cancers in the 12 months prior to diagnosis were excluded. Distinct lines of treatment (LOT) were established using business rules, and incidence rates of PN for each LOT were calculated. We identified predictors of PN development any time after treatment start by carrying out a stepwise Cox regression analysis using 27 covariates. Results: Of the identified 63,174 NSCLC patients, 26,061 had LOT 1, 9,938 had LOT 2, and 4,790 had LOT 3. Incidence rates for all patients, and those with and without a history of PN and diabetes for LOTs 1-3 and across all LOTs of a patient are shown in Table 1. Of the 27 covariates in the Cox regression, age65 (HR: 0.94; p¼0.0083), male gender (HR: 1.12; p<0.0001), Asian race (HR: 0.72, p¼0.0034), squamous cell histology (HR: 1.13; p<0.0001), a history of peripheral neuropathy (HR: 2.86; p <0.0001), and a history of diabetes (HR: 1.37; p <0.0001) were found to be significant predictors of developing PN. Conclusion:Of all treated NSCLC patients, more than a quarter develop PN over the course of their treatments. Incidence rates increase with each LOT indicating an increased risk as patients continue treatment. Identifying covariates associated with PN allows identification of highrisk patients, which may contribute to lowering the risk of developing PN.
lung specific antigens (TTF1 and Napsin) besides EMA, P40, CK7, Synaptophysin, Chromogranin A, CD56, Calretinin, PD-L1, ALK (D5F3) by immunocytochemistry (ICC). EGFR mutations, ALK, RET and ROS1 fusions were evaluated from plasma by NGS. Results: C-TACs (EPCAM and CK positive) could be obtained from 458 samples out of 498 (92.0 %). Among the 95 samples that were characterised by staining for organ specific antigens, 100 % samples were positive for Napsin whilst 67.0 % samples were TTF1 positive. Classification of lung cancer subtypes of adenocarcinoma, adenosquamous carcinoma, squamous cell carcinoma and neuroendocrine tumors was possible in 94 out of 95 samples (98.9 %). ctDNA was obtained from 332 samples. EGFR mutations were detected in 110 (33.1 %) samples, which had concordance with tissue EGFR status in 89 % of 124 EGFR positive samples. ALK fusion was detected in 2 (0.6 %) samples which had concordance of 100 % with tissue ALK status. None of the tissue evaluated carried RET or ROS1 fusion and none were detected in any plasma sample. Conclusion: Our results show that ICC based characterization of C-TACs can provide necessary diagnostic information non-invasively to substitute conventional procedures dependent on tissue extraction. Additionally, ctDNA based detection of molecular characteristics completes most clinical decision-making requirements in lung cancer.
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