Germ Cell Tumor Complicated by Mediastinal Mass Syndrome: A Report of Cardiac Arrest to Full Recovery.

Germ cell tumors (GCTs) are the most common malignancies in men aged 15-35 years. Five percent of malignant GCTs are of extragonadal origin, and the most common extragonadal location for GCTs in adults is the mediastinum. Like other mediastinal tumors, mediastinal GCTs may cause compression or invasion of vital mediastinal structures, resulting in respiratory or hemodynamic compromise. Right ventricular failure following positive pressure ventilation of such patients is called mediastinal mass syndrome (MMS). This report presents a case of a GCT complicated by cardiac arrest shortly after starting positive pressure ventilation, which was successfully resuscitated. Few previous reports demonstrated a successful outcome of MMS. This report highlights the importance of a multidisciplinary approach for such scenarios in light of the scanty literature and lack of clear guidance and the significance of starting chemotherapy in a timely manner.

Successful Management of Acute Promyelocytic Leukemia in a Patient Who Presented With Acute Ischemic Stroke on Top of Subdural Hematoma.

Acute promyelocytic leukemia (APL), a distinct subtype of acute myelogenous leukemia (AML), is commonly associated with a heightened risk of bleeding due to coagulopathy. Thrombotic events, although less frequent, have also been linked to APL. However, the occurrence of ischemic stroke as an initial presentation of APL, particularly concomitant with central nervous system (CNS) bleeding, is exceedingly rare. The combination of these two complications is not reported in APL patients and is anticipated to carry a high mortality rate even with treatment. In this report, we describe the case of a young female patient with no significant medical history, who presented with decreased consciousness and recurrent seizures. Brain magnetic resonance imaging (MRI) revealed the simultaneous occurrence of acute ischemic stroke and acute-on-chronic subdural hematoma. The subsequent bone marrow biopsy confirmed the diagnosis of APL, displaying the characteristic positive promyelocytic leukemia (PML)-retinoic acid receptor alpha (RARA) t(15;17) translocation. The patient was promptly initiated on a high-risk AML-M3 protocol, coupled with supportive treatment through platelet transfusion. Remarkably, a favorable response to treatment was observed, and a marked improvement in her neurological parameters was observed within 2 weeks duration of treatment. Subsequent assessment through a bone marrow biopsy one month later revealed complete remission, with the PML-RARA fusion gene becoming negative following a single course of consolidation therapy.

Adherence to oral anticancer hormonal therapy in breast cancer patients and its relationship with treatment satisfaction: an important insight from a developing country.

BACKGROUND: Hormone-positive breast cancer is the most common type and represents a burden in all countries. Treatment satisfaction might be a predictor for adherence, as higher satisfaction with medication encourages patients to adhere appropriately to the medication and, consequently, successfully achieve the treatment goals. The present study evaluated the adherence of women with hormone-positive breast cancer to oral hormonal drugs and correlated it with treatment satisfaction and other sociodemographic and clinical factors. METHODS: A cross-sectional design was applied. This study included two cancer centers. Data were collected from patients through face-to-face interviews and medical record reviews. The Medication Adherence Scale was adapted to assess medication adherence, and the Treatment Satisfaction Questionnaire for Medication (TSQM) version 1.4 was adopted to measure treatment satisfaction. RESULTS: The final analysis included 106 patients, with a mean age ± SD of 51.9 ± 1.2. Approximately 35% were hospitalized in the past year. Current hormonal therapy among cancer patients included letrozole (38.7%), tamoxifen (31.1%), exemestane (17%), and anastrozole (13.2%). The median adherence score was 5.0 [4.8-6.0], and 62.3% adhered fully to their oral hormonal drugs in the past week. The median scores of effectiveness, side effects, convenience, and global satisfaction were 66.67 [61.11.0-72.22], 75.00 [48.44-100.00], 66.67 [66.67-72.22], and 71.43 [57.14-78.57], respectively. A significantly lower adherence score was identified in patients living in camps (p = 0.020). Patients with comorbidities and those who continued on the same hormonal therapy had higher adherence scores, although they were not statistically significant. Multiple linear regression analysis showed that two domains of treatment satisfaction, side effects (p = 0.013) and global satisfaction (p = 0.018), were predictors of adherence to oral hormonal drugs. CONCLUSIONS: The current study revealed a significant association between treatment satisfaction and adherence to oral hormonal therapy. We recommend creating a specialized scale to measure adherence, considering the psychosocial factors that affect hormonal anticancer medication adherence.

Epidemiology and source of infection in cancer patients with febrile neutropenia: an experience from a developing country.

BACKGROUND: Febrile neutropenia (FN) is a life-threatening complication that predisposes cancer patients to serious infections. This study aims to describe the epidemiology and source of infection in cancer patients with FN in a tertiary care hospital. METHODS: A hospital-based retrospective study was conducted in a large tertiary care hospital from January 2020 to December 2021. Data on cancer patients with FN were collected from the hospital information system. RESULTS: 150 cancer patients with FN were identified during the study period. Most patients were males (98; 65.3%), and the mean age of participants was 42.2 ± 16.0 years. Most patients (127; 84.7%) had hematologic malignancies, and acute myeloid leukemia was the most common diagnosis (42; 28%), followed by acute lymphocytic leukemia (28; 18.7%) and Hodgkin's lymphoma (20; 13.3%). Fifty-four (36%) patients had a median Multinational Association for Supportive Care in Cancer (MASCC) scores greater than 21. Regarding the outcome, nine (6%) died, and 141(94%) were discharged. The focus of fever was unknown in most patients (108; 72%). Among the known origins of fever were colitis (12; 8%), pneumonia (8; 5.3%), cellulitis (6; 4%), bloodstream infections (7; 4.6%), perianal abscess (2; 1.3%) and others. The median duration of fever was two days, and the median duration of neutropenia was seven days. Sixty-three (42%) patients had infections: 56 (73.3%) were bacterial, four (2.6%) were viral, two (1%) were fungal and 1 (0.7%) was parasitic. Among the bacterial causes, 50 cases (89.2%) were culture-positive. Among the culture-positive cases, 34 (68%) were gram-positive and 22 (44%) were gram-negative. The most frequent gram-positive bacteria were E. faecalis (9; 18% of culture-positive cases), and the most frequent gram-negative organisms were Klebsiella pneumoniae (5; 10%). Levofloxacin was the most commonly used prophylactic antibiotic (23; 15.33%), followed by acyclovir (1610.7%) and fluconazole in 15 patients (10%). Amikacin was the most popular empiric therapy, followed by piperacillin/tazobactam (74; 49.3%), ceftazidime (70; 46.7%), and vancomycin (63; 42%). One-third of E. faecalis isolates were resistant to ampicillin. Approximately two-thirds of Klebsiella pneumoniae isolates were resistant to piperacillin/tazobactam and ceftazidime. Amikacin resistance was proven in 20% of isolates. CONCLUSIONS: The majority of patients suffered from hematologic malignancies. Less than half of the patients had infections, and the majority were bacterial. Gram-positive bacteria comprised two-thirds of cases. Therefore, empiric therapy was appropriate and in accordance with the antibiogram of the isolated bacteria.

Current global research landscape on COVID-19 and cancer: Bibliometric and visualization analysis.

BACKGROUND: Cancer is a severe public health issue that seriously jeopardizes global health. In individuals with coronavirus disease 2019 (COVID-19), cancer is considered an independent risk factor for severe illness and increased mortality. AIM: To identify research hotspots and prospects, we used bibliometrics to examine the global production of COVID-19 literature published in the field of oncology. METHODS: Data on publication output were identified based on the Scopus database between January 1, 2020, and June 21, 2022. This study used VOSviewer to analyze collaboration networks among countries and assess the terms most often used in the titles and abstracts of retrieved publications to determine research hotspots linked to cancer and COVID-19. The Impact Index Per Article for the top 10 high-cited papers collected from Reference Citation Analysis (RCA) are presented. RESULTS: A total of 7015 publications were retrieved from the database. The United States published the greatest number of articles (2025; 28.87%), followed by Italy (964; 13.74%), the United Kingdom (839; 11.96%), and China (538; 7.67%). The University of Texas MD Anderson Cancer Center (n = 205, 2.92%) ranked first, followed by the Memorial Sloan-Kettering Cancer Center (n = 176, 2.51%). The European Journal of Cancer (n = 106, 1.51%) ranked first, followed by the Frontiers in Oncology (n = 104, 1.48%), Cancers (n = 102, 1.45%), and Pediatric Blood and Cancer (n = 95; 1.35%). The hot topics were stratified into "cancer care management during the COVID-19 pandemic"; and "COVID-19 vaccines in cancer patients". CONCLUSION: This is the first bibliometric analysis to determine the present state and upcoming hot themes related to cancer and COVID-19 and vice versa using VOSviewer during the early stages of the pandemic. The emergence of hot themes related to cancer and COVID-19 may aid researchers in identifying new research areas in this field.

Successful Treatment for Isolated Bone Marrow Hodgkin Lymphoma in an Human Immunodeficiency Virus (HIV)-Negative Patient.

BACKGROUND Hodgkin lymphoma is a type of lymphoid neoplasm characterized by the presence of Reed-Sternberg cells in histopathology. It presents with swollen lymph nodes, and in advanced cases, it can involve bone marrow. Isolated and primary involvement of Hodgkin lymphoma in bone marrow is a very rare presentation, especially in an HIV-negative patient, and has a high mortality rate, even with appropriate management. CASE REPORT A 36-year-old male patient presented with a 6-month history of chills, night sweats, and generalized weakness. Laboratory investigations showed pancytopenia. A peripheral blood smear was unremarkable. A bone marrow biopsy revealed Reed-Sternberg cells, consistent with Hodgkin lymphoma. Further imaging did not show any lymphadenopathy, and the spleen was normal. Therefore, primary bone marrow Hodgkin lymphoma was diagnosed at stage IV, with an International Prognostic Score of 5 potential unfavorable factors. He was started on conventional chemotherapy for Hodgkin lymphoma and received the first cycle of ABVD (adriamycin, bleomycin, vinblastine, and dacarbazine) during his hospitalization. Meanwhile, he had fever without focus, and was managed empirically by broad-spectrum antibiotic treatment (piperacillin-tazobactam). Hospitalization lasted for 2 weeks. He continued to receive other cycles as an outpatient, with good clinical response. The patient remained in complete remission after 2 years. CONCLUSIONS Isolated Hodgkin lymphoma of bone marrow is a very rare scenario, especially in HIV-negative patients, with no established management for patients. Here, we report a patient successfully treated with a conventional chemotherapy protocol for Hodgkin lymphoma.

Diffuse large B-cell lymphoma with uncommon cardiac invasion.

Diffuse large B-cell lymphoma is the most common histologic subtype of non-Hodgkin lymphoma. Secondary involvement of the heart is seen late in advanced cases, it is uncommon for diffuse large B-cell lymphoma to present as intracardiac mass. A 26-year-old female patient presented with progressive shortness of breath, facial swelling, and lower limb edema. Imaging investigations by echocardiography and computed tomography showed a large right atrial mass that was obstructing the tricuspid valve. Open biopsy was taken, histopathology showed diffuse large B-cell lymphoma. She received six cycles R-CHOP chemotherapy (rituximab, cyclophosphamide, epirubicin, vincristine, and prednisone) with complete resolution of the mass. Diffuse large B-cell lymphoma can present with atypical and uncommon sites such as the heart as the first presentation. Early diagnosis and appropriate management is crucial given the poor outcome with late presentation. A high index of suspicion and the proper investigations is recommended to allow for early intervention and favorable outcomes as what happened with the case under discussion.

The Impact of Non-Compliance to a Standardized Risk-Adjusted Protocol on Recurrence, Progression, and Mortality in Non-Muscle Invasive Bladder Cancer.

PURPOSE: Non-muscle invasive bladder cancer (NMIBC) is a potentially curable or controllable disease if strict adherence to a surveillance protocol is followed. Management and surveillance of NMIBC begins at the time of diagnosis up to a few years thereafter. There is scanty data in the literature evaluating the impact of non-compliance with the surveillance protocols on progression, recurrence, and mortality rate. PATIENTS AND METHODS: An observational, retrospective cohort study recruited data between 2012 and 2017 at two tertiary hospitals. Data were collected consecutively. NMIBC patients who had at least 3 years of follow-up data were included. Patients were divided into different groups based on their compliance with the cystoscopy follow-up protocol as recommended by the European guidelines. We compared the cystoscopy compliant group with the non-compliant group in view of recurrence, progression, and mortality. In addition, missing variable items during surveillance were calculated using a new scoring model to predict adverse outcomes. RESULTS: Eighty-eight NMIBC patients met our criteria. Recurrence rate (RR), progression rate (PR), metastasis rate (MsR), and mortality rate (MR) are significantly higher in non-compliant group, RR: (92.6%) (P<0.001), PR: (54.1%) (P<0.001), MsR: (37.7%) (P<0.001), MR: (23.5%) (P= 0.002) respectively. In the subgroup analysis, intermediate and high-risk groups have a PR rate of zero in the compliant group, while it is 100% (P<0.001) and 56.4% (P=0.001) in the non-compliant group, respectively. Use of a Kaplan Meier (KM) graph shows that compliant patients had a better survival in comparison to non-compliant patients. Scoring there or more is statistically and clinically significantly associated with higher recurrence, progression, and mortality. RR: (94%) (P=0.016), PR: 49% (P<0.001) and MR (26%) (P=0.012). CONCLUSION: Non-compliance to a standardized surveillance protocol in NMIBC is associated statistically and clinically with adverse outcomes in comparison to a compliant group. This mandates strict adherence to surveillance guidelines particularly in patients with high-risk disease.