Harnessing the immune system through programmed death-1 blockade in the management of Hodgkin lymphoma.

Immunotherapy is a rapidly evolving therapeutic option in the treatment of lymphoma. Neoplastic cells evade immune recognition through the programmed death (PD)-1/PD-ligand immune checkpoint pathway. Several novel agents have been developed to restore the immune system's ability to recognize and destroy cancer cells. Nivolumab and pembrolizumab are two anti-PD-1 antibodies that have demonstrated success in the treatment of refractory Hodgkin lymphoma. Harnessing the immune system's ability to target neoplastic cells, ideally without the use of cytotoxic chemotherapeutic agents, is one way in which these novel agents are changing the therapeutic landscape in the treatment of lymphomas. Here, we review the emerging data regarding checkpoint inhibitors in the management of Hodgkin lymphoma, the unique adverse effects encountered with the use of these agents, and a practical approach to the management of these adverse effects. Additionally, we discuss upcoming trials that will further assess the promising future developments of checkpoint inhibition in the treatment of not only Hodgkin lymphoma but also other B cell lymphomas and myeloma. These agents offer immense promise of a future where many lymphomas can be treated without the toxic effects of chemotherapeutic agents.

THERAPY-RELATED T/MYELOID MIXED PHENOTYPE ACUTE LEUKEMIA IN A PATIENT TREATED WITH CHEMOTHERAPY FOR CUTANEOUS DIFFUSE LARGE B CELL LYMPHOMA.

Mixed-phenotype acute leukemia is a rare form of leukemia that is associated with a poor prognosis. Most cases of mixed-phenotype acute leukemia are de novo. However, therapy-related mixed-phenotype acute leukemia can occur, and are often associated with exposure to topoisomerase-II inhibitors and alkylating agents. There are no known treatment guidelines for therapy-related mixed-phenotype acute leukemia. We present a patient with T/myeloid mixed-phenotype acute leukemia secondary to rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone R-CHOP chemotherapy for primary cutaneous diffuse large B-cell lymphoma. The patient's leukemic cells express CD34, an immaturity marker, CD3, a T-cell marker, and myeloperoxidase, a myeloid marker, and her history of chemotherapy for previous lymphoma supports the diagnosis of therapy-related T/myeloid mixed phenotype acute leukemia. Clinicians should be aware that this entity could be associated with R-CHOP chemotherapy. Given the complexity in diagnosis, and lack of treatment guidelines, a further understanding of the pathological and genetic principles of therapy-related mixed-phenotype acute leukemia will assist in future efforts to treat and categorize these patients. Mixed phenotype acute leukemia is a rare entity that accounts for two to five percent of all acute leukemias. Therapy- related mixed phenotype acute leukemia is an exceedingly rare hematological neoplasm that accounts for less than one percent of acute leukemias. We describe a case of therapy-related T/myeloid mixed phenotype acute leukemia following rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone R-CHOP chemotherapy for primary cutaneous diffuse large B-cell lymphoma DLBCL. The patient is a 63-year-old female who presented with several cutaneous nodules diagnosed as primary cutaneous DLBCL. The patient received R-CHOP chemotherapy and achieved remission. She remained in remission for four years until she presented with dyspnea, night sweats, weakness, and diffuse lymphadenopathy. Her presentation was initially concerning for recurrent lymphoma; however, a bone marrow biopsy and aspirate and a lymph node biopsy revealed a distinct blast population consistent with T/myeloid mixed phenotype acute leukemia T/M-MPAL. Given the patient's history of previous chemotherapy exposure, our patient represents a case of therapy-related T/myeloid mixed phenotype acute leukemia t-MPAL.

Antemortem Diagnosis of Likely Giant Cell Carcinoma of the Lung by Pleural Fluid Cytology Evaluation.

BACKGROUND: Sarcomatoid carcinomas (SCs) are poorly differentiated non-small cell lung carcinomas containing components of either sarcomatoid differentiation or true sarcoma. SCs have a poor prognosis; some studies suggest a 6-month survival rate <27%. CASE REPORT: We present a case of the rare entity of SC, likely giant cell carcinoma, that is unique because our patient was older than the mean age at presentation, was female, and had a central lesion. CONCLUSION: Clinicians need to be aware of the histologic entities of SCs of the lung because of the aggressive nature of these lesions and because of the need for further studies to determine possible treatment regimens.

Sneaky Sarcoidosis or a Metastatic Masquerade? - A case of nodular sarcoidosis.

Sarcoidosis is a multisystem disease of unclear pathogenesis that peaks between ages 20 to 39. Sarcoidosis is more common in women and affects blacks three times more frequently than whites. Nodular sarcoidosis is a rare variant of sarcoid that occurs in 1-4 percent of patients. It presents in female smokers with cough and shortness of breath. Nodular sarcoidosis often also presents as multifocal bilateral ill-defined nodules mimicking airspace disease or malignancy on imaging. Patients generally have a favorable prognosis, with complete resolution of the masses with steroid treatment. Herein, we present a case of nodular sarcoidosis in a female smoker who presented with cough, weight loss, and fever. Imaging revealed multiple pulmonary nodules, a dominant lung mass, and lymphadenopathy suggestive of malignancy. Ultimately, the patient underwent bronchoscopy and was diagnosed with nodular sarcoidosis; there was no evidence of malignancy or infectious process. Resolution of her symptoms ensued with steroid treatment.

Hepatocellular carcinoma with extension to the heart via the inferior vena cava.

Hepatocellular carcinoma (HCC) is the third-leading cause of cancer-related mortality worldwide. Most cases of HCC are associated with cirrhosis from various causes such as alcohol or viral hepatitis. Most patients are symptomatic as a result of cirrhosis itself or secondary to tumor extension. These tumors have an affinity for the vasculature and often invade the portal system. HCC rarely causes invasion of the inferior vena cava or the heart. We, however, present a case of HCC in a patient without cirrhosis who remained asymptomatic despite having tumor extension to the heart by way of the inferior vena cava. The mean survival in patients with intracardiac extension with or without aggressive treatment or intervention is approximately 4 months, but our patient greatly exceeded survival expectations after treatment with sorafenib.