Rationale:Male adenomyoepithelioma of the breast with malignant features is a rare tumor with only one previous case reported in the literature over 25 years ago.Patient concerns:We report the case of a 63-year-old man admitted to our Oncology Institute with a painless tumor mass of 6 cm in the left breast with no additional regional lymph nodes. Ultrasound revealed a complex cystic tumor mass of 60 mm in the left breast, with both anechoic (cystic) and echogenic (solid) components, with ill-defined margin.Diagnoses:Extemporaneous assessment showed a solid (invasive) papillary intracystic carcinoma. Definitive pathology examination revealed the presence of a breast malignant adenomyoepithelioma.Interventions:Based on the extemporaneous assessment, wide tumor excision was performed. The tumor board decided to continue treatment with adjuvant anthracycline-based chemotherapy.Outcomes:After 6 years of follow-up, the patient is cancer-free. No chronic side effects were noted.Lessons:Because this pathology is extremely rare, no guidelines are available for its therapeutic approach. All decisions regarding patient management should be made by a multi-disciplinary team and can only be based on clinical experience and the few cases reported in female patients.

No abstract

Despite a well characterized mechanism, Myasthenia gravis (MG) remains a dilemma in terms of etiology. Several case reports and series of cases suggest a potential cause-effect relation between SARS-CoV-2 infection or vaccination and MG. We present the case of an autoimmune MG occurring post Covid-19 in an elderly male, vaccinated with three doses of the BNT162b2/Pfizer-BioNTech vaccine. The 78-year-old male was admitted in the Neurology Clinic in early November 2021 with double vision, bilateral ptosis, dysphonia and dysphagia, 16 days after receiving a third dose of the BNT162b2/Pfizer-BioNTech SARS-CoV-2 vaccine and 12 days after testing positive for SARS-CoV-2 infection. The symptoms began to emerge at 9 days after COVID-19 diagnosis. Clinical neurological examination included ice-pack test and intramuscular neostigmine, both with positive results. Myasthenia gravis positive diagnosis was confirmed by slow repetitive nerve stimulation and abnormally increased serum levels of antibodies against acetylcholine receptors. Due to patient’s refusal of further hospitalization, he was discharged with therapy recommendations. Under treatment with oral pyridostigmine, but no oral corticosteroid due to therapeutic noncompliance, the patient was readmitted two months later with aggravated symptoms. The myasthenic crisis was successfully treated with intravenous immunoglobulins, corticosteroid therapy and oral pyridostigmine. The novelty of the current case resides in the fact that, to the best of our knowledge, appears to be the first case of MG clinically manifested after COVID-19 infection in a fully vaccinated patient.

Prostate cancer is the second most common malignancy in men. The androgenic receptor (AR) is the main therapeutic target for this type of cancer, hormone therapy being the cornerstone of patient management, despite resistance developing over time in some cases. The scientific concern and practical necessity for more effective therapies have led to the introduction of novel drug classes, including new taxanes, PARP inhibitors and immunotherapeutic agents. Studies regarding the complex mechanisms of action which account for the therapeutic effects of these drugs are supported by clinical trials which confirm the optimization of survival parameters. The present article summarizes current diagnostic and therapeutic trends in prostate cancer treatment; it is organized in distinct sections aimed at: (i) the evolution of different concepts and approaches in the histopathological classification, (ii) the structure and function of the androgenic receptor and its truncated variant 7, considered a clear indicator of the lack of response to hormone treatment, (iii) the therapeutic principles in both localized and locally advanced prostate cancer, (iv) the innovative strategies in treating castration-resistant and metastatic prostate cancer. Reviewing these recent and complex aspects generates a meaningful insight regarding the advancements in patient-tailored diagnosis and therapy, aimed at individualized treatment that reconciles both the biological profile and the subjective choices of the patient. RezumatCancerul de prostată reprezintă a doua cea mai comună neoplazie la bărbați. Receptorul androgenic (RA) reprezintă principala țintă terapeutică, hormonoterapia constituind axul critic al tratamentului -dar unii pacienți dezvoltă însă, în timp, rezistență. Interesul științific pentru dezvoltarea unor terapii mai eficiente a condus la introducerea unor noi clase de medicamente, care includ taxani de generație nouă, inhibitori PARP și agenți imunoterapeutici. Cercetarea mecanismelor de acțiune complexe care stau la baza efectelor terapeutice este susținută prin studii clinice care confirmă optimizarea parametrilor de supraviețuire. Articolul concentrează repere diagnostice și terapeutice actuale operaționale în cancerul de prostată. Parcurgerea informației este facilitată prin organizarea în secțiuni distincte care vizează: (i) evoluția noțiunilor și conceptelor în clasificarea histopatologică, (ii) structura și funcția receptorului androgenic și a variantei 7 trunchiate, considerată indicator absolut al lipsei de răspuns la tratamentul hormonal, (iii) principii terapeutice în cancerul de prostată localizat şi local avansat, (iv) strategii inovative în tratamentul cancerului de prostată rezistent la castrare şi metastatic. Trecerea în revistă a informației recente permite astfel o imagine de ansamblu a progreselor înregistrate în diagnosticul și terapia centrată pe pacient, în efortul de a stabili un tratament individualizat, concordant cu profilul biologic obiectiv și opțiunile subiective ale acestuia.

No abstract

Homeobox B13 (HOXB13) and trefoil factor 3 (TFF3) are novel candidates for the classification of prostate cancer (PC) in molecular subtypes that could predict the clinical evolution of patients. The aim of our study was to analyze the possible associations between HOXB13 and TFF3 immunohistochemical (IHC) expression in sporadic prostate adenocarcinoma (PAC), the potential prognostic value in relation to the classical clinico-pathological parameters, as well as their role in defining distinct molecular subtypes of this malignancy. The study group comprised 105 patients diagnosed with PAC who underwent radical prostatectomy. IHC exam was performed using anti-HOXB13 and anti-TFF3 antibodies and a scoring system that permit the separation of the cases into two subgroups, with low and high immunoexpression, respectively. The statistical analysis evaluated the relationship between the two immunomarkers and clinico-pathological parameters. The Kaplan-Meier curves and log-rank Mantel-Cox test were used for assessing the prostate-specific antigen (PSA)-progression free survival. Four subgroups of PAC were defined based on the IHC overexpression and low immunoexpression of HOXB13 and TFF3. High HOXB13 and TFF3 immunoexpression was commonly identified in cases characterized by a Gleason score over 7, a G4 or G5 dominant pattern, a grade group of 3 or 4 and a preoperatory PSA serum level over 20 ng/mL. HOXB13 overexpression was also associated with pathological tumor-node-metastasis (pTNM) stage. The subgroup with both low HOXB13 and TFF3 immunoexpression had the highest PSA-progression free interval, whereas the subgroup with high HOXB13 immunoexpression and low TFF3 immunoexpression presented the lowest rate, but no statistically significant differences were registered. Our results sustain the role of HOXB13 and TFF3 in the stratification of PAC. Further investigations in larger cohorts are imposed to validate the clinical significance of these subgroups in the diagnostic and prognostic of PAC.

No abstract