A 26-year-old female with metastatic primary gastrointestinal malignancy presenting as menorrhagia.

Krukenberg tumor is a metastatic malignant tumor of the ovary arising from a wide variety of primary sources, with the stomach being the most common. The presenting symptoms are non-specific and the primary source is often un-identified. Here, we describe a case of a 26-year-old Hispanic gravida 4, para 3 female who presented to our hospital with dysuria, pelvic pain and irregular, heavy menstrual cycles for three months duration. An endometrial biopsy was suggestive of carcinosarcoma. The patient underwent debulking surgery with partial cystectomy and bladder repair. A week later, she presented with hematemesis and an endoscopic biopsy revealed a diagnosis of poorly differentiated gastric adenocarcinoma. The tissue specimen obtained during the initial surgery was identified as Krukenberg tumor. The patient underwent adjuvant chemotherapy with FOLFOX along with gastrectomy with intraperitoneal chemotherapy.

Pancytopenia in a 70-year-old african-american male: an unusual presentation of a rare disease.

Hairy cell leukemia is a rare lymphoid neoplasm arising from mature B-lymphocytes. Clinically, the disease presents with splenomegaly and abdominal discomfort, frequent infections, fatigue and bleeding because of related cytopenias. Bone marrow biopsy is essential for diagnosis. Below we describe a case of a 70-year-old African-American male who presented to our hematology clinic complaining of fatigue. Clinical exam and computed tomography imaging did not reveal splenic enlargement. Blood work-up revealed pancytopenia and bone marrow was diagnostic for hairy cell leukemia.The patient was started on cladribine, with gradual improvement of his symptoms and blood count abnormalities. Therefore, it is essential to keep hairy cell leukemia in the differential of pancytopenia even in the absence of a splenomegaly.

Papillary serous carcinoma of the uterine cervix with lung metastasis.

Papillary serous carcinoma of the uterine cervix is a rare histological variant of cervical adenocarcinoma, with a very small number of cases reported. It is an aggressive tumor and is usually diagnosed at advanced stages by the time of diagnosis. Early-stage tumors can be treated with surgery and/or radiotherapy, while late-stage tumors have been treated with chemotherapy plus radical surgery with intermittent success. Here we report a case of metastatic papillary serous carcinoma observed at our hospital, which has been treated with debulking surgery and combination chemotherapy with carboplatin and paclitaxel.

A puzzle of hemolytic anemia, iron and vitamin B12 deficiencies in a 52-year-old male.

A 52-year-old male with no significant past medical history reports increasing generalized fatigue and weakness for the past 2 weeks. Physical examination reveals jaundice and pallor without organomegaly or lymphadenopathy. His hemoglobin was 5.9 g/dL with a mean corpuscular volume of 87.1 fL and elevated red blood cell distribution width of 30.7%. His liver function test was normal except for elevated total bilirubin of 3.7 mg/dL. Serum LDH was 701 IU/L, and serum haptoglobin was undetectable. Further investigation revealed serum vitamin B12 of <30 pg/mL with elevated methylmalonic acid and homocysteine level. In addition, serum ferritin and transferrin saturation were low. The patient was diagnosed with hemolytic anemia secondary to vitamin B12 deficiency with concomitant iron deficiency anemia.

Primary diffuse large B-cell lymphoma of the ascending colon.

Primary colorectal lymphoma is a rare malignancy accounting for 3% of all gastrointestinal lymphomas and 0.1-0.5% of all colorectal malignancies. Among primary colorectal lymphomas, the most common histological subtype of colorectal lymphoma is diffuse large B-cell lymphoma. We report a case of an 84-year old Caucasian female who was admitted to the hospital because of a 2 days history of altered mental status. In the emergency department the patient was found to have acute kidney injury and hypercalcemia. On physical examination a large lower quadrant abdominal mass was palpated. Computed tomography scan of abdomen confirmed the presence of a mass along the cecum and proximal ascending colon. Colonoscopy showed a large ulcerated mass and biopsy was consistent with diffuse large B-cell lymphoma. The patient underwent colectomy but refused to receive chemotherapy.

Left inguinal adenopathy two years after cytoreductive surgery: a rare sign of recurrence.

Ovarian cancer is the second most common gynecological cancer in the Western world. Despite a good response to treatment, most patients with ovarian cancer will relapse. The abdominal, pelvic, and retroperitoneal cavities represent the most common sites of ovarian cancer recurrence, with inguinal lymph node involvement rarely reported. Herein we report the case of a 48-year-old Caucasian female who underwent successful surgical and chemotherapy treatment for ovarian epithelial cancer. Two years later, the patient was found to have painless left inguinal adenopathy, which was subsequently found to be metastatic ovarian cancer. CA-125 levels were elevated despite the lack of any foci of metabolically active tissue on imaging. Inguinal lymph node involvement is a rare sign of ovarian cancer. Despite that, it is essential to consider ovarian cancer in the differential diagnosis for inguinal lymphadenopathy in a female patient.

Aggressive multimodal approach for anaplastic thyroid cancer and long-term survival.

Anaplastic thyroid cancer (ATC) comprises 1-2% of all thyroid cancers and is one of the most aggressive cancers with a median survival rate of around four months. The average 5-year survival rate has been reported to be around 3.6%. In this paper, we have discussed management and prognostic variables of a patient with ATC who has survived for more than 5 years. A 59-year-old female was referred to our facility for an elective thyroid and parathyroidectomy for concerns of thyroid papillary cancer and hyperparathyroidism. At the time of surgery, the tumor mass had invaded the muscular layer of esophagus; radicle thyroidectomy parathyroidectomy along with removal of muscle layer of esophagus was performed, and diagnosis of ATC was made. The patient was treated with chemoradiation with a good treatment response and no recurrence of tumor for two and a half years until PET/CT followed by wedge biopsy of lung confirmed ATC recurrence. The patient was treated with another course of radiation treatment with a good treatment response. Since then, the patient has been following in our outpatient oncology clinic and has no evidence of tumor recurrence. Aggressive multimodal approach of combining radicle surgery with chemoradiation treatment in select patients of ATC with no distant metastasis helps improve prognosis.

Management of metastatic ovarian Sertoli-Leydig cell tumor with sporadic multinodular goiter: a case report and literature review.

Information regarding treatment for patients with metastatic ovarian Sertoli-Leydig cell tumor (SLCT) has been extremely limited. We report a young woman whose stage IA, poorly differentiated SLCT was initially managed surgically 9 months earlier, and who presented with extensively metastatic SLCT. She had a dramatic response to the combination of bleomycin, etoposide and cisplatin followed by stem cell transplantation and surgery, and has shown no evidence of disease recurrence for 8 months postoperatively. The patient was also found to have sporadic non-toxic multinodular goiter, which has not changed over the treatment course as mentioned. A review of the literature concerning the management of metastatic ovarian SLCT, along with its coexistence with multinodular goiter, is presented.