An unusual presentation of an aggressive spindle cell skin cancer.

Spindle cell squamous cell carcinoma (SCSCC) is a rare subtype of squamous cell carcinoma (SCC) that was first reported around 1900. Its potential for metastasis is uncertain. There has been noted a relationship to previous exposure to radiation therapy with subsequent aggressive presentation. We report an unusual case of a widely metastatic, poorly differentiated cutaneous spindle cell neoplasm with a rapidly progressive clinical course and dismal outcome in several days. This is one of a very few cases in the literature in which a skin cancer recurs with such diffuse metastasis and disastrous outcome.

Triple-negative breast cancer: future prospects in diagnosis and management.

Triple-negative breast cancer (TNBC) is an aggressive subtype comprising about 10-20 % of breast cancer patients with an overall poor prognosis. Recently, it was found to be a heterogeneous disease that has been classified into six subtypes based on molecular signature. In preclinical trials, these subtypes have different active signaling pathways with variable response to chemotherapy. To improve treatment outcome of TNBC, therapy should be tailored according to the active driving signaling aberration. Molecular testing represents the optimal way to stratify patients, but it has some difficulties to be implemented in routine clinical practice. This article provides an assumption for stepped diagnostic algorithm of TNBC based on immunohistochemistry markers in addition to a suggested tailored therapeutic strategy for advanced TNBC based on the driving aberrations. Furthermore, most TNBC patients develop early relapse despite adjuvant chemotherapy. We provide a design for future adjuvant therapy for the disease. This design is based on targeting proposed active pathways in breast cancer stem cells responsible for regenerating the tumor and disease relapse. Finally, we provide a proposed design for future clinical trials in TNBC to allow for investigation of different medications in this heterogeneous disease based on upfront patient stratification and then allocation to the suitable treatment arms.

A Phase II trial of split, low-dose docetaxel and low-dose capecitabine: a tolerable and efficacious regimen in the first-line treatment of patients with HER2/neu-negative metastatic breast cancer.

BACKGROUND: Successful therapeutic regimens in metastatic breast cancer (MBC) must balance efficacy and tolerability. Docetaxel/capecitabine is an active and commonly used doublet in this setting. Docetaxel upregulates thymidine phosphorylase and thus potentiates the antitumor effects of capecitabine. A schedule with split, low-dose docetaxel in combination with low-dose capecitabine could improve the therapeutic index of this regimen without compromising its clinical activity. PATIENTS AND METHODS: Patients with previously untreated HER2/neu-negative MBC were eligible. Treatment consisted of docetaxel 25 mg/m2 on days 1 and 8 in combination with capecitabine 750 mg/m2 twice daily on days 1-14 of a 3-week cycle. Thirty-nine women were enrolled. Median age was 55 years (range, 36-75 years). Fourteen patients had triple-negative disease. Sites of metastasis were as follows: bone (n = 27); liver (n = 15); lung (n = 17); nonregional chest (n = 4); lymph nodes (n = 2); and skin (n = 1). Six patients had bone-only disease. All subjects had a performance status of 0/1. A total of 329 cycles were administered (median, 6; range, 1-50). RESULTS: Of 37 patients who received study treatment, 32 had evaluable disease, 1 had a complete response, and 15 had a partial response (overall response rate was 50% in evaluable patients and 43% in the intent-to-treat analysis). Six patients had stable disease. The overall clinical benefit rate was 69% for patients with evaluable disease and 60% overall. Fifteen patients had disease that progressed or had been withdrawn from study at the time of first evaluation. With a median follow-up of 25 months, median time to treatment failure was 4.25 months (95% CI, 1.5-7 months), and median overall survival has not yet been reached. Toxicity was moderate: 15 patients (41%) had grade 3/4 adverse events. CONCLUSION: Split, low-dose docetaxel and low-dose capecitabine is an active combination in the first-line treatment of patients with MBC. Toxicity with this schedule was manageable, making it an attractive regimen for further study in combination with targeted agents.

Primary lymphoblastic B-cell lymphoma of the cranial dura mater: a case report and review of the literature.

Primary lymphomas of the cranial dura mater are rare. Mucosa-associated lymphoid tissue extranodal marginal zone lymphomas are the most common subtype of non-Hodgkin's lymphomas that present as primary cranial dura tumors. A 33 year-old male presented with a 3-month history of a growing lump in the right frontal area. Neuroimaging studies demonstrated an extra-axial, broad-based mass with a dural tail in the right frontal bone convexity. Biopsy led to the diagnosis of localized dural precursor B-cell lymphoblastic lymphoma. The patient was treated with a combination of chemotherapy and radiotherapy, achieving durable disease-free survival. This is the first report of precursor B-cell lymphoblastic lymphoma of dura mater. A review of the literature on primary lymphomas of cranial dura mater is presented. Primary lymphomas of the cranial dura mater are rare. Mucosa-associated lymphoid tissue extranodal marginal zone lymphomas are the most common subtype of non-Hodgkin's lymphomas that present as primary cranial dura tumors. A 33 year-old male presented with a 3-month history of a growing lump in the right frontal area. Neuroimaging studies demonstrated an extra-axial, broad-based mass with a dural tail in the right frontal bone convexity. Biopsy led to the diagnosis of localized dural precursor B-cell lymphoblastic lymphoma. The patient was treated with a combination of chemotherapy and radiotherapy, achieving durable disease-free survival. This is the first report of precursor B-cell lymphoblastic lymphoma of dura mater. A review of the literature on primary lymphomas of cranial dura mater is presented.

Prevalence of hepatitis C infection in patients with non-Hodgkin's lymphoma in South Florida and review of the literature.

The etiology of non-Hodgkin's lymphoma is unknown in the majority of the cases. Although Epstein-Barr virus, human T-cell leukemia-lymphoma virus and human herpes virus-8 have been established as casual agents in the pathogenesis of specific types of lymphoma, the role of hepatitis C virus (HCV) in lymphomagenesis remains controversial, with marked geographic variability. We conducted an epidemiologic study to evaluate the prevalence of hepatitis C virus infection in patients with lymphoma in South Florida. Ninety consecutive patients with lymphoma and 96 consecutive control patients with solid tumors were tested for HCV. HCV infection was detected in 2 patients with NHL (2.2%) and in 4 control patients (4.1%). Our study does not support the association between HCV and lymphoma in South Florida, US.