Cancer
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Item Early Recurrent Granulosa Cell Neoplasm: a Case Report(2020) Moorhead, AvaA 61 year-old woman who has a history of a granulosa cell neoplasm (GCT), removed 1 year prior, presents to the office with increasing abdominal girth and severe limitations in bowel habits. She had been chronically constipated with difficulty walking and transferring secondary to pelvic and abdominal pain. Her primary neoplasm was excised at 15cm in conjunction with a total abdominal hysterectomy and bilateral salpingo-oophorectomy. Upon imaging in August 2019, a new mass was seen measuring at 15cm with septations and loculations; suspicious for a possible recurrent tumor. Surgical excision was planned and executed without morcellation. Extensive carcinomatosis of the small and large bowel were seen, necessitating 2 bowel resections that were successful but leaving the patient with a temporary ileostomy. To date, she has been inconsistent with follow-up and discussion of the necessity of chemotherapy is pending. This patient is unusual in that her GCT was malignant and recurrent, but also the speed at which it returned, only 1.5 years later; both factors being unexpected for this type of tumor.Item OCIMUM TENUIFLORUM DECREASES THE RATE OF GROWTH AND METASTATIC POTENTIAL OF MURINE 4T1 MAMMARY CARCINOMA CELLS(2020) Moore, Cayla; Quinn, Bryon; Jones, Harlan; Donkor, MichaelCombination therapies involving chemotherapy and radiation, aimed at reducing metastasis and mortality have faced challenges, including limiting the effectiveness of immunotherapy. Ocimum tenuiflorum (O. tenuiflorum) has been used traditionally in Indian culture for the treatment of disease and proven scientifically to have immunomodulatory effects. The purpose of this study was to determine the anti-tumor effect of the natural plant O. tenuiflorum on 4T1 murine mammary carcinoma cells (4T1). Hypothesis: O. tenuiflorum decreases the rate of growth and metastatic potential of 4T1 tumor cells. Method: 4T1 cells were grown in culture medium and exposed to increasing concentrations of O. tenuiflorum. The metastatic potential was determined using the scratch assay technique. We were also interested in the mechanism by which O. tenuiflorum decreased the rate of growth and metastatic potential of 4T1 cells. Therefore, we determined the changes in the mRNA expression of IL-4R, previously reported to drive breast cancer metastasis following exposure of 4T1 tumor cells to O. tenuiflorum. Results: Exposing 4T1 cells to various concentrations of O. tenuiflorum decreased the rate of growth and metastatic potential of 4T1 tumor cells. Also, O. tenuiflorum downregulated the expression of IL-4R by 4T1 tumor cells with increasing concentration. We conclude that O. tenuiflorum has the potential to be used as adjunct treatment in management of breast cancer. Further studies will investigate in-depth the mechanism of O. tenuiflorum on 4T1 including apoptosis, migration and other molecular mechanism on tumor evasiveness.Item Targeted treatment for SHH+ Medulloblastoma in a pediatric patient with Gorlin Syndrome(2020) Johnnidis, MelissaBackground: We present a case of metastatic medulloblastoma (MB) of the sonic hedgehog (SHH) molecular subgroup in a patient with previously undiagnosed Gorlin syndrome who was subsequently treated with Vismodegib, a hedgehog signaling pathway inhibitor. A 4-year-old female presented with a 6-month history of worsening ataxia. Imaging revealed a mass which was determined to be MB following biopsy. Genetic testing identified a PTCH1 gene mutation, consistent with the diagnosis of Gorlin syndrome. Objectives: To describe a case of a patient with Gorlin syndrome and metastatic medulloblastoma treated with Vismodegib, a targeted therapy for the SHH molecular subgroup of the tumor. Design/Methods: A chart review was performed for this single case study. Results: The tumor was determined to be SHH+ MB. With the Gorlin syndrome diagnosis, radiotherapy (RT) was not recommended due to the increased risk of developing basal cell carcinomas, which are common in the disease. The tumor was resistant to chemotherapy, so she started Vismodegib. The drug was initially beneficial until months later when further metastases were found on imaging. Conclusion: Mainstay treatment of MB consists of a combined-modality approach utilizing RT, which is risky in Gorlin syndrome patients. The use of Vismodegib as targeted therapy in our patient seemed promising, but the tumor progressed. We present this case to raise awareness to the potential complications of treating MB in those with Gorlin syndrome. Multi-institutional studies are required to determine whether the drug should be given to patients with Gorlin syndrome and SHH+ MB.Item The Genetic Link between Phocomelia, Endometrial Stromal Sarcoma and Dysplastic Marrow: A Case Study(2020) Hamby, Tyler; Howrey, Richard; Garcia, LauraBackground: Phocomelia is a malformation of the upper limbs, which can occur from various causes such as genetics, spontaneous mutation, and in utero teratogenic exposure (e.g., thalidomide). It is often associated with other congenital malformations. Myelodysplastic syndrome (MDS) signifies ineffective hematopoiesis. Patients are often asymptomatic and diagnosed through an incidental finding. However, there is risk of progression to myeloid leukemia for which a bone marrow transplant is needed for cure. Endometrial stromal sarcoma (ESS) is a rare, malignant uterine tumor most often seen in women 40 to 55 years of age. It is characterized by myometrial invasion with polymenorrhagia at presentation. We report a case of phocomelia, MDS, and ESS in a pediatric patient, which demonstrates the impact a genetic link can have in clinical management. Case Information: Patient is a 20-year-old female with phocomelia of the upper extremities. She presented with dysfunctional bleeding, which was thought to be secondary to uterine fibroids. An MRI was performed for evaluation and revealed a uterine sarcoma. Pre-operative screening revealed pancytopenia with intermittently persistent thrombocytopenia and dysplastic marrow with suspected MDS. Conclusion: With the presentation of three seemingly unrelated disorders, it is important to consider an underlying genetic link. There was suspicion that a chromosome 7 abnormality could link phocomelia, ESS and MDS, leading to a high risk of progression to leukemia. However, microarray analysis revealed a genetic mutation associated with thrombocytopenia absent-radius syndrome, which has a much lower likelihood of progression to bone marrow malignancy in the future.Item Delayed Methotrexate Excretion Due to Sequestration in a Thymic Cyst(2020) Deville, HeatherBackground: High-Dose Methotrexate (HD-MTX) is extremely effective in childhood cancers; yet, it has many side effects due to its toxic potential. It is important that HD-MTX levels are continuously monitored. The normal timeframe for HD-MTX clearance is 2-3 days. In most patients, the levels should decline as the kidneys filter the medicine from the blood; however, prolonged excretion can result from HD-MTX accumulating in "third spaces'', for example pleural effusions or ascites. Case Information: A 16-year-old female patient was admitted for HD-MTX for osteosarcoma in 2019. During her first cycle of HDMTX, she experienced delayed clearance of MTX taking approximately 7.00 days, requiring prolonged hospitalization for drug level monitoring as well as monitoring for renal toxicity. Over the next two months, her clearance remained prolonged at 5.95 days and 7.08 days. Six weeks later, the patient presented to the clinic with chest pain. Upon evaluation, a CT angiogram revealed an elongated cystic structure in the superior mediastinum. The cyst was surgically removed. The patient cleared her next two scheduled HD-MTX treatments at 10- and 11-weeks post-diagnosis, in 2.66 and 2.93 days, respectively. Conclusions: This case study brings to light a rare occurrence of MTX sequestration within a pre-existing benign thymic cyst, leading to prolonged time to MTX clearance, prolonged hospitalization, and extended leucovorin rescue. It would be prudent to consider imaging patients with persistent delayed MTX excretion, looking for unusual areas where 3rd spacing may occur.Item Hypertension Management in Cancer Patients Receiving Oral Chemotherapy or Hormonal Therapy(2020) Monestime, Shanada; Wiliam, Jordan; Page, Ray; Magallon, TaraPurpose: For cancer patients, primary care providers (PCP) are the mainstay for chronic disease management, such as hypertension. However, studies show many cancer patients do not have a PCP and prefer to see their specialists. This poses a greater concern to patients receiving oral chemotherapy or hormonal therapy (HT) due to fewer clinic visits, which puts hypertensive patients at risk for going untreated and undermanaged. This study evaluates hypertension management in patients receiving oral chemotherapy or HT. Methods: A retrospective chart review was conducted at a community oncology clinic to identify patients with a baseline blood pressure (BP) reading ? 120/80 mmHg and were newly initiated on oral chemotherapy or HT. Two to three BP readings recorded on separate visits were evaluated, averaged, and classified. Hypertension was defined by a systolic ? 140 or diastolic ? 90 mmHg or a systolic ? 130 or diastolic ? 80 mmHg with a diagnosis of chronic kidney disease or diabetes. Results: Of the 75 patients analyzed, 41% (n=31) of patients were found to be hypertensive. The systolic BP mean was 145 (range, 130-200) and the diastolic mean was 80 (range, 58-97) mmHg. Forty-eight percent (n=15) of hypertensive patients did not have hypertension listed as a condition on their electronic record and 26% (n =8) were not receiving antihypertensive agents. Conclusion: Over 1/3rd of patients receiving oral chemotherapy or HT were found to have unmanaged hypertension, which emphasizes the need for coordination of care amongst community oncology and primary care clinics.Item Radical Resection of a Primary Inferior Vena Cava Leiomyosarcoma: A Case Study(2020) Jackson, Terrence; Jeyarajah, Dhiresh; Sudanagunta, SnehaBackground: Leiomyosarcomas (LMS) are rare soft tissue tumors that arise from smooth muscle. Of the five different classifications of LMS, the vascular LMS subtype has a predilection for major blood vessels, such as the inferior vena cava (IVC). Primary IVC LMSs affect approximately 1/100,000 people and have a very poor prognosis. They can lead to an array of symptoms that are often associated with other etiologies and can be fatal if not diagnosed accurately and treated appropriately. Case information: A 54-year-old Caucasian female presented to the hepato-pancreatico-biliary surgery clinic for assessment of a firm right upper quadrant abdominal mass. Upon further workup and imaging, a large mass within her IVC was found. A biopsy of the mass showed necrotic tissue that was non-diagnostic but concerning for malignancy. This lead to a successful radical surgical resection of the mass and adjacent structures with placement of an IVC graft. Additionally, chemotherapy and radiation was started to decrease chances of recurrence. Conclusion: Leiomyosarcomas of large blood vessels are at a greater risk of affecting associated organs based on their location and extent of vessel involvement. Though primary vascular LMSs are rare, they can be treatable if they are correctly identified early in the disease progression. This case demonstrates that careful radical resection of a primary IVC LMS should be considered as a treatment modality, in addition to chemotherapy and radiation, for patients with these rare and potentially fatal tumors.Item Retroperitoneal Cystic Lymphangioma: A Rare Presentation(2020) Robbins, Daniel; Cameron, Benjamin; Elete, KunalBackground: Lymphangiomas are benign congenital malformations of lymphatic vessels that are usually detected by the second year of life. They commonly affect the neck (75%) and axilla (20%) whereas fewer than 5% are reported to be intra-abdominal. Around 70% of intra-abdominal lymphangiomas are intraperitoneal in the small bowel mesentery but presented here is a case of a retroperitoneal mesenteric cystic lymphangioma. Case Information: A 55-year-old female with a surgical history of hysterectomy, bilateral oophorectomy, and laparoscopic adjustable gastric band was referred to surgery with a three-to-four-month history of bloating, early satiety, and lower abdominal discomfort. She denied changes in weight, appetite, or bowel movements. On previous abdominal CT, the lap-band appeared unremarkable, but there was an incidental discovery of a mass near the cecum and ascending colon. After a negative colonoscopy, she underwent repeat CT with contrast, which showed interval growth of the mass from 1.2x4.3 cm to 1.5x5.1 cm. Due to uncertainty of its nature and inaccessibility via percutaneous biopsy, a laparoscopic right hemicolectomy was recommended in addition to removal of the lap band, the latter of which was felt to be causing her symptoms. During surgery, the mass was identified in the right mesocolon and found to be cystic and multilobulated, and it was resected. Histopathology showed a CD34 positive cystic lesion filled with lymphoid nodules, confirming the diagnosis of cystic lymphangioma. Conclusion: This case illustrates a unique presentation of a condition rarely encountered in adulthood.Item Young Female with Breast Cancer Found to Have Positive Mutations in ATM, PALB2, and FLCN (Birt-Hogg-Dube Syndrome)(2020) Benichou, ChloeMost breast cancers are sporadic, however, about 6% of breast cancers are attributed to single pathogenic variants of breast cancer susceptibility genes. A 25-year-old woman, positive for a previously known ATM mutation, presented with newly diagnosed right breast cancer. She had presented to her primary care physician after feeling a lump but was assured her ultrasound showed no worrisome findings due to her young age. Three months later, when her symptoms were worsening, she received a mammogram, ultrasound, and biopsy, which found her to have invasive ductal carcinoma and ductal carcinoma in situ of the right breast. The patient's family history included renal cell carcinoma, colon, prostate, and pancreatic cancer. A multi-gene panel was found to be positive for mutations in ATM, PALB2, and FLCN. The patient underwent chemotherapy and a modified radical mastectomy of the right breast and is being closely monitored while she completes radiation. The multiple mutations found in the patient's genome drastically increased her risk of developing breast cancer. Not only is the FLCN mutation uncommon, occurring in approximately 200 families world-wide, but the combination of three genetic mutations that increased her risk of breast cancer is exceptional. Due to the rarity of breast cancer in a woman under 30 and the paucity of multiple mutations, the patient's concerns were not given adequate attention and her cancer was undiagnosed for a prolonged period of time. This highlights the importance of genetic testing and close monitoring of high-risk patients influencing future care.Item Genomic Profiling of Pediatric Tumors: A Single Institution Experience(2020) Pham, Robin; Hamby, Tyler; Ray, Anish; Swilling, AubreyPurpose The goal of this project is to study the prevalence of potentially actionable oncogenic variants in a sample of pediatric tumors, to identify agents that may target those variants, and to highlight the potential utility of targeted therapies in pediatric cancers. This study will also describe the tumor mutation burden (TMB), microsatellite instability (MSI), and programmed death-ligand 1 (PD-L1) status of the included samples. Methods Retrospective chart review was conducted on 82 patients treated for cancer who underwent molecular sequencing from 2013 to 2019 at Cook Children's Medical Center. Tumor samples were sent to Foundation Medicine, Inc. for sequencing, which identified genetic variants and available approved or experimental targeted therapies. When requested, reports included TMB, MSI, and PD-L1 status. Results There were 5 patients with central nervous system tumors, 4 patients with leukemia and lymphoma, 33 patients with neuroblastoma, and 40 patients with other solid tumors. Thirty-five (43%) patients were identified as having actionable genetic alterations, and 13 (16%) patients received targeted therapy. Thirty-four patients were tested for PD-L1 status and 6 (18%) were positive. TMB was determined for 51 patients: 44 (86%) were low burden, 7 (14%) intermediate burden, and none were high burden. MSI status was determined for 41 patients and all were MSI-stable. Conclusion Whole genome sequencing has emerged as a tool to identify driver genetic alterations in various tumors. This study highlights how tumor profiling can be utilized to identify potential molecular targets and biomarkers in pediatric cancers.Item The anti-cancer activity of clotam derivatives against high-risk neuroblastoma cell lines(2020) Basha, Riyaz; Bowman, William; Sankpal, Umesh; Smith, Chloe; Hernandez, Yazmin; Holder, Alvin; Lambring, Christoffer B.Purpose: Neuroblastoma (NB) is the most common extracranial cancer diagnosed in infants and young children. High Risk Neuroblastoma (HRNB) is more aggressive with (40-50%) 5-year survival rates. Our laboratory is testing combination treatments using less toxic agents to sensitize HRNB cells to chemotherapy. The anti-cancer activity of a Non-Steroidal Anti-Inflammatory Drug, tolfenamic acid (TA), against HRNB cells has been shown. TA inhibits Specificity protein 1 (Sp1) and survivin, markers that are associated with aggressive cancer cell growth and resistance to chemo/radiation therapies. The objective of this study is to evaluate the effectiveness of TA and Copper-TA (Cu-TA) to inhibit HRNB cell growth alongside chemotherapy agent Vincristine (VCR). Methods: Anti-proliferative activity of TA or Cu-TA and/or (VCR) against HRNB cell lines, LA-155n and SMS-KCNR, and non-malignant cells, cardiomyocytes was evaluated using CellTiterGlo kit. Dose curves were plotted, and IC50 values were determined by Sigma-Plot software. The expression of Sp1 and survivin was determined by Western bot analysis. Results: When compared to TA, Cu-TA's IC50 values were about 50% less. TA and Cu-TA didn't affect cell viability of cardiomyocytes at IC50 doses. Cu-TA inhibited the expression of Sp1 and survivin in HRNB cells. The combination of Cu-TA and VCR showed higher efficiency for inhibiting HRNB cells. Conclusions: In conclusion, Cu-TA may effectively sensitize certain HRNB cells and induce the response of chemotherapy. Studies to understand the mechanism of action of Cu-TA are underway.Item Spinal Metastasis(2020) Gilani, Salaman; Zaman, ImaadClassification: TCOM DO Student (1st Year) Department: TCOM: Internal Medicine & Geriatrics Authors: Salaman Gilani; Imaad Zaman Background: Metastatic lung cancer is cancer that originated in the lungs, but cancer cells separated from the main tumor are transmitted via lymphatic or hematologic pathways to other sites of the body. When a broken cell finds an attachment site it can begin to proliferate and form another mass with the same properties as the original tumor, often invading into the spaces of other organs and structures into the body. This can impair homeostasis and cause varying degrees of discomfort or pathologies. Lung cancers most often metastasize to nervous system structures (47%), bones (39%), and the liver (35%). Approximately two-thirds of patients with cancer will form a metastasis later on. Case Information: During dissection of an 80 year old male cadaver a spinal metastasis was found at the articulation of the 7th rib and the 7th thoracic vertebra. Conclusion: This report aims to further information regarding metastases to the spine from lung cancer. This pathology in our cadaver was selected due to its rarity and the opportunity it presents to learn about uncommon metastatic cancers. This metastasis was diverting the vena cava and thoracic duct in addition to displacing the spine from its resting position. Spinal metastases can cause pain, stability issues of the spine and depending on how far into the spine the cancer has invaded, can also present with neurological issues.Item Mechanistic Studies of Cytotoxic Activity of the Mesoionic Compound MIH 2.4Bl in MCF-7 Breast Cancer Cells(2020) Mathis, Michael; Costa, Luciana; Dibnath, DiptiPurpose: In this work, we examined the cytotoxic effect of a 1,3-thiazolium-5-thiolate derivative of a mesoionic compound (MIH 2.4Bl) on the MCF-7 breast cancer cell line. Methods: The cytotoxic effect of MIH 2.4Bl was determined using a crystal violet assay. The effect of MIH 2.4Bl on mitochondrial respiration was characterized by an oxygen consumption rate (OCR) analysis. Autophagy induction by MIH 2.4Bl was examined by measuring changes in protein markers. Microarray analysis was performed to assess changes in gene expression after MIH 2.4Bl treatment. Six genes were selected for expression verification by RT-qPCR, including ACRC, AMIGO2, ATF3, DKK1, HBEGF, and RGS2. Results: An IC50 value of 45.8 +/- 0.8 µM was determined for MIH 2.4Bl. Increasing concentrations of MIH 2.4Bl resulted in a reduction of all mitochondrial respiration parameters compared to control cells, indicative of an overall decrease in mitochondrial membrane potential. Western blot analysis showed the with MIH 2.4Bl resulted in increased protein expression of Beclin-1 and ATG5 and an increase in the in LC3B-II/LC3B-I ratio compared to control cells. We demonstrated 3644 genes with a fold-change ? 2 change with 775 up-regulated and 2869 down-regulated by MIH 2.4Bl compared with control cells. RT-qPCR analysis of RNA isolated from control and MIH-2.4Bl treated MCF-7 cells showed a correlation of altered expression levels with changes in expression identified by microarray analysis. Conclusion: These results suggest that MIH 2.4Bl is a promising candidate for treating breast cancer.Item Case Report: Rectourethral fistula, a rare complication following prostate cancer external beam radiation and brachytherapy(2020) Hey, Wayne; Kulp, DennisBackground: Prostate cancer is the second most common cancer in men; 11% of men will receive a diagnosis of prostate cancer throughout their lifetime. In most cases, the cancer is asymptomatic and localized. Because of its indolent growth, many treatment modalities are available including radical prostatectomy, external beam radiation, brachytherapy, cryotherapy, and thermal ablation. Post-operative complications of these procedures include erectile dysfunction, urinary incontinence, urethral stenosis, and rectourethral fistula (RUF). RUF is an abnormal connection allowing passage of contents between the bladder and rectum. This rare and serious complication typically presents in older patients after transurethral resection of the prostate or post-radiation biopsy and requires extensive surgical salvage or diversion to repair. Case Presentation: A 49-year-old male with a past medical history of erectile dysfunction and elevated was diagnosed with prostate cancer following a biopsy showing Gleason Score 3+4=7 in 1/12 cores and Gleason 6 in 1/12 cores. He was referred to oncology and subsequently underwent external beam radiotherapy and brachytherapy with radiation seed placement. One year later, he presented to the clinic with pneumaturia, urinary diarrhea, and incontinence per urethra. His presentation suggested an RUF confirmed by cystoscopy which showed a posterior urethral tear immediately distal to the external urethral sphincter at the 7 o'clock position. The patient was referred for imaging and surgical evaluation for further management. Conclusion: Here we present the rare complication of rectourethral fistula formation in a young patient after external beam radiation in conjunction with brachytherapy.Item Functional characterization of a macrophage-polarizing agent loaded in reconstituted high-density lipoprotein nanoparticles for cancer immunotherapy(2020) Lacko, Andras G.; Sabnis, Nirupama; Dossou, AkpedjePurpose: The murine stimulator of interferon genes agonist 5,6-dimethylxanthenone-4-acetic acid (DMXAA) has been successfully used to modulate the function of macrophages from an immunosuppressive phenotype (M2) to a proinflammatory phenotype (M1). Drugs, such as DMXAA, that facilitate this phenotype reversal are particularly relevant in cancer therapy as the immunosuppressive phenotype of tumor-associated macrophages (TAMs) contributes to tumor progression. This functional reprogramming of TAMs by drugs, including DMXAA, has been reported to facilitate sustained tumor regression. However, drug targeting strategies are needed to specifically deliver reversal agents to TAMs and avoid off-target effects. In this study, we investigated the physicochemical characteristics, as well as phenotype reversal capability of DMXAA encapsulated in the biocompatible reconstituted high-density lipoprotein (rHDL) nanoparticles. Methods: The DMXAA-loaded rHDL (rHDL-DMXAA) was prepared using an enhanced microfluidics apparatus. Dynamic light scattering (DLS) and fast protein liquid chromatography (FPLC) were used to assess particle size and preparation homogeneity. M1 and M2 markers expression by murine macrophages were assessed via western blot and ELISA. Results: While DLS indicated particles of 33.9 ± 14 nm diameter size, the FPLC profile of preparation indicated a homogeneous preparation with an estimated particle molecular weight of 132 kDa. Upon treatment with rHDL-DMXAA, the macrophages showed increased M1 marker expression. Conclusion: rHDL-DMXAA induced an M1 phenotype in macrophages and its characteristics suggest a potential for intratumoral accumulation. Thus, the rHDL-DMXAA represents a functional proof-of-concept strategy to target macrophages with implications in cancer immunotherapy.Item Assessing the cytotoxicity of investigational agent for cancer therapy against non-malignant cells(2020) Patel, Krishna; Mukka, Lasya; Sankpal, Umesh; Basha, Riyaz; Siraj, SohailBackground: The treatment of cancer requires chemotherapy (ChT). Most of ChT agents exhibit unwanted side-effect and cause damage to healthy cells. Side effects from commonly used ChT agents are leaving pediatric cancer survivors with lasting damage to organ systems, specifically the heart. Studies conducted by our group demonstrated the anti-cancer activity of clotam (tolfenamic acid-TA) and copper-clotam (Cu-TA). Cu-TA is showing higher cytotoxicity against cancer cells even at much lower dose than TA in pancreatic cancer cells. Our long term objective is to test these agents to sensitize cancer cells to ChT. Methods: Cardiomyocytes H9c2 (cell line derived from rat heart tissue) originally obtained from the American Type Culture Collection (Manassas, VA) were cultured as per the supplier's instructions. H9c2 cells were treated with TA or Cu-TA or Doxorubicin and combinations (for example, TA and Doxorubicin) and cell viability assay was measured using CellTiter-Glo (Promega) kit at 48 hours post-treatment following manufacturer's instructions. Results & Conclusion: We found that TA or Cu-TA are not inducing toxicity in H9c2 cells at tested doses. TA kept more cells alive in conjunction with Doxorubicin than did the control. Our studies also show that H9c2 cells are not toxic to IC50 values of TA or Cu-TA determined with cancer cells. These results provide evidence that the tested investigational gents are not inducing toxicity in cardiomyocytes at tested doses and supports use of these agents in combination therapy with ChT.Item A Rare Case of Synchronous Gallbladder Metastasis Secondary to Gastric Adenocarcinoma(2020) Jackson, Terrence; Nagatomo, Kei; Osman, Houssam; Jeyarajah, Dhiresh; Cho, Edward; Lim, JosephBackground: Gallbladder metastasis is rare and usually presents in the end stage of a malignancy. When they do occur, most of the time it is secondary to melanoma. However, there have been case reports of gallbladder metastasis secondary to gastric cancer; this has been reported in Asian countries such as Japan, South Korea, and Turkey where gastric cancer rates are higher than western countries. This is the first case of gallbladder metastasis secondary to gastric cancer in the United States to ever be reported. Case Presentation: A 67-year-old female initially developed hematemesis, and further workup showed gastric cancer with initial pathology showing T3N0M0. Clinically she was asymptomatic. Patient underwent total gastrectomy with roux-en-y esophagojejunostomy and cholecystectomy. The final pathology showed T3N2M1 gastric adenocarcinoma with metastatic adenocarcinoma of the gallbladder. Conclusion: This is a very rare case adds to the limited literature on this topic. Due to lack of level one data on gallbladder metastasis in general, case reports such as this one provides a unique and valuable insight into this pathology.Item Unusual Presentation of Stroke-like Symptoms due to Diffuse Infiltrating Glioma with Primary Glioblastoma(2020) Alford, Brent; Farrell, MollyBackground: Gliomatosis cerebri is a rare glioma with poor prognosis and has a non-specific clinical presentation. It has an incidence of 0.1 per 1,000,000 and a median survival of 9 months. Under the latest classification, it is not its own class of tumor, due to a lack of genotypic differentiation from other gliomas. It is considered a unique growth pattern including more than three cerebral lobes. There is no known cause for such extensive invasion of this tumor. Case Presentation: An 81-year-old male presented to a Brazilian hospital with right-sided weakness and speech difficulty consistent with a stroke. In the United States, imaging of the brain showed extensive areas of irregularly thickened signal throughout the cerebral hemispheres and brainstem, consistent with gliomatosis cerebri, and an enhancing mass in the right parietal lobe. There was no evidence of a previous stroke. The patient had a physical exam significant for close to full strength throughout his right upper and lower extremities. The patient underwent a right parietal craniotomy with resection of the right parietal lesion. The patient had an uneventful recovery and was referred to neuro-oncology for further treatment recommendations. Conclusion: There is no current standard of care for gliomatosis cerebri. Treatment for this tumor typically includes chemotherapy and radiation. Surgical intervention of tumor resection is often limited due to the diffuse nature. More research is needed to develop a standard of care for gliomatosis cerebri and discover the unknown etiology of the distinctive growth pattern.Item Adolescents and Young Adults with Cancer Continue to Face Disparities in Rate of Change in Five-Year Survival(2020) Bowman, William; Rutledge, Laura; Bleyer, Archie; Ewart, MackenziePurpose: Cancer is a devastating disease process that affects the lives of millions around the world. A standard metric of progress, of particular interest within the discipline of cancer research is the measurement of therapeutic progress, which is commonly measured through analyses of 5-year survival statistics. While cancer therapies have come a long way, the adolescent and young adult (AYA) cancer patient population faces many unique obstacles such as cancer identification, proper diagnosis, adequate treatment, and continuity of care. It has been estimated that globally there are more than one million incident cases of cancer in AYAs between 15 and 39 years, and nearly 400,000 deaths due to cancer in the age group. These obstacles have led to a lack of improvement in the outcomes for AYA cancer patients of 15 to 39 years of age when compared with younger and older patient populations Methods: Large-data analysis via mathematical derivation of 5-year survival statistics from the National Cancer Institute Surveillance, Epidemiology, and End Results Program (SEER) registries from 1975-2009. Results: The analysis yields a measurable disparity in the therapeutic improvement of the AYA cancer patient population when compared against the derivation of 5-year survival statistics for children and middle-aged or older adults within United States. Conclusions: Despite recent publications and analyses that state the contrary - more initiatives and research are needed to correct the lagging disparities and to improve the overall survival in the AYA population.Item Case report of suspected primary pulmonary choriocarcinoma in a 43 year old male presenting for treatment of H. pylori(2020) Troutman, Monte; Nguyen, Ryan; Roy, Joyce; Young, MatthewBACKGROUND: Choriocarcinoma is a rare cancer in males and is usually derived from the testicular intratubular germ cells. Extra-gonadal origins of the disease are possible but even more rare. Previous population analysis has shown the overall rate to be approximately 0.022 per 100,000. Among these, mediastinal-pulmonary origin is among the more common derivations and carries a poor prognosis. CASE INFORMATION: We present a case of a 43 year old male who presented to the gastrointestinal service for treatment of positive H. pylori from his primary care physician after a work up for abdominal pain, nausea and vomiting. A chest x-ray ordered for complaint of hemoptysis on intake history and physical revealed a large mediastinal mass and many disseminated opacities suspicious for metastatic disease. Further work-up revealed the lesion, originally thought to be squamous cell in origin, to be choriocarcinoma and a negative testicular ultrasound, despite a beta-hcg of over 10,000, led to a presumptive diagnosis of primary pulmonary choriocarcinoma (PCC). CONCLUSIONS: PCC is not entirely well studied due to its rarity and our case serves to illuminate an unusual presentation of a rare disease in a patient presenting to primary care with a very common complaint. Understanding of rare diseases and their warning symptoms serves to better prepare clinicians to catch rare and potentially lethal conditions that might otherwise be missed and lead to devastating consequences for patients.
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