Parosteal Osteosarcoma with Pancreatic Metastasis and Multiple Relapses: A Case Report and Review of the Literature.

Osteosarcoma is the most common primary bone cancer in all age groups. Metastasis mostly occurs with high-grade tumors disseminating to the lungs and other bones. Spread to the pancreas is rare and undocumented in the low-grade subtypes. Additionally, it is uncommon for the disease course of low-grade subtypes to involve multiple relapses. We present a 35-year-old woman with parosteal osteosarcoma who has experienced an atypical metastasis to the pancreas as well as multiple local and pulmonary relapses. The lesion was identified incidentally on routine imaging, and the patient underwent resection. We compare our case to the other reports of pancreatic metastasis in the literature. Despite being especially rare, clinicians ought to be aware of pancreatic metastasis of osteosarcoma. Furthermore, despite parosteal osteosarcoma's less aggressive disease course, it can uncommonly lead to multiple relapses. We present a rare case exemplifying these phenomena in the prognostically favorable histologic subtype of parosteal osteosarcoma.

Neutrophilic eccrine hidradenitis secondary to pegfilgrastim in a patient with synovial sarcoma.

Here, we report a case of neutrophilic eccrine hidradenitis (NEH) in a teenage male with synovial sarcoma associated with extracutaneous manifestations including myositis and splenomegaly secondary to pegfilgrastim. To the best of our knowledge, NEH has not been previously reported to occur in association with extracutaneous manifestations.

Individual Experiences and Utilization of Supportive Resources in Adolescents and Young Adults with Cancer.

Background: Adolescents and young adults (AYAs) with cancer are often impacted by distress due to disease and treatment. Despite these concerns, prior research has found that AYAs do not utilize support resources, do not find these resources adequate, and or do not have adequate access to services. Objective: The objective of this project was to understand and identify AYA patient concerns and experiences throughout cancer treatment, what resources were utilized, how they were identified, and how supportive care resources for AYA cancer patients can be improved. Methods: Twenty-eight AYA cancer patients and survivors were interviewed on their experiences and utilization of supportive resources throughout cancer treatment. Qualitative data were analyzed using thematic analysis and organized through a priori framework examining specific domains of experience and resources utilized. Results: The most frequently discussed topic in qualitative interviews was the benefit of the health care team. Other frequently identified resources were generalized internet searches and webpages. Suggested unmet resource needs included supportive resources for family members and caregivers throughout the time of treatment. Conclusions: AYAs experience stress throughout treatment for cancer attributed to physical, practical, and psychosocial causes. Health care workers play a vital role in serving as an informative and supportive resource for their AYA patients. As such, health care workers and other supportive resources may alleviate these concerns, but these resources are still underexplored.

Understanding the functional late effects and informational needs of adult survivors of childhood cancer.

PURPOSE/OBJECTIVES: To report functional (physical and cognitive) late effects, experiences, and information needs of adult survivors of childhood cancer. DESIGN: Descriptive, mixed methods survey. SETTING: Two pediatric oncology programs in the Midwest. SAMPLE: Convenience sample of 272 young adult survivors. METHODS: Voluntary survey completion by young adult survivors regarding late effects, experiences, and educational needs to develop appropriate comprehensive care programs for care provision before, during, and after transition to adult care. Survey domains were identified from existing survivorship literature and focused on all aspects of survivorship; however, this article focuses on results specific to the functional domain. MAIN RESEARCH VARIABLES: Functional late effects, experiences, information needs, age, gender, and treatment intensity of young adult survivors of childhood cancer. FINDINGS: Response rate was 48%. Functional late effects, perceptions, and information needs all correlated with intensity of treatment (those survivors most heavily treated experienced the most symptoms). Survivors wanted more information about late effects and how to deal with them. Women wanted more information about fertility-related topics, and participants who received more intense treatment generally wanted more information. Brain tumor survivors perceived greater cognitive difficulties, cognitive late effects, fatigue, and financial difficulties. CONCLUSIONS: Survivors experience myriad physical late effects and require ongoing access to information as needs change over time. IMPLICATIONS FOR NURSING: Identifying new and innovative ways to reach survivors and better meet needs is important for care, research, and program development. KNOWLEDGE TRANSLATION: The findings of the research underscore the importance of continuous learning opportunities for adult survivors of childhood cancer. The findings also highlight the need for healthcare teams to better understand the current and long-term needs of this population. In addition to traditional communication approaches, technologies such as social media and telemedicine can provide innovative ways to deliver patient-centered care.

New onset psychosis in an adolescent during treatment of testicular germ cell tumor.

Germ cell tumor of the testis is the most common malignancy in young males between 15 and 45 years of age. Side effects of treatment are common, but psychiatric reactions have not been reported. We describe a case of a 16-year-old male patient with nonseminomatous germ cell tumor of the testis treated with orchiectomy and bleomycin, etoposide, and cisplatin chemotherapy. Treatment was complicated by the development of psychosis after first chemotherapy cycle. Etiology of psychosis was most likely multifactorial including stress related to cancer diagnosis and treatment, psychosocial and family stressors, history of traumatic brain injury, and corticosteroid medication.

Romidepsin (FK228/depsipeptide) controls growth and induces apoptosis in neuroblastoma tumor cells.

As histone deacetylase inhibitors such as romidepsin (depsipeptide, FK228) complete successful Phase I clinical trials in pediatric solid tumors, it is important that their mechanisms of action are delineated in order to inform the development of subsequent clinical trials as single agents or in combination therapies. In this study, we evaluate the effect of romidepsin as a single agent on a number of different neuroblastoma (NB) cell lines. We find that the growth of 6/6 human NB tumor cell lines but not an immortalized fibroblast cell line (NIH3T3) is inhibited by romidepsin (IC(50) = 1-6.5 ng/ml) after 72 h of treatment. Romidepsin shows selective dose-dependent cytotoxicity in both single copy and N-myc amplified NB cell lines, in cell lines with wild type or mutant p53 and those containing Alk mutations. The decrease in cell proliferation is accompanied by caspase-dependent apoptosis as shown by PARP cleavage, an accumulation of cells in the sub-G(1) phase of the cell cycle and the ability of a pan-caspase inhibitor to reduce cell death. Romidepsin inhibits the growth of subcutaneous NB xenografts in a dose dependent manner in immunocompromised mice. Furthermore, romidepsin induces expression of genes such as p21 and expression of p75 and NTRK (TrkA) which are more highly expressed in the tumors from NB patients that have a good prognosis. These studies support continued investigations into the therapeutic activity of romidepsin in NB.

Antiphospholipids antibodies in a 12-month-old presenting with idiopathic thrombocytopenic purpura.

A 12-month-old Caucasian female with a history of recurrent ear infections presented to the emergency room with petechiae, severe thrombocytopenia (4000/microL), and abnormally prolonged activated partial thromboplastin time. Further autoantibody investigation detected antinuclear antibodies, anti-double-stranded DNA, and antiphospholipid antibodies. Platelet count, in response to intravenous immunoglobulin infusion, increased to more than 100 x 10(3) plt/microL. At 6-month follow-up, no positive autoantibodies were detected.

Recurrent central nervous system blastomycosis in an immunocompetent child treated successfully with sequential liposomal amphotericin B and voriconazole.

Central nervous system involvement in infection with Blastomyces dermatitidis is uncommon, except in immunocompromised patients. We report a case of central nervous system blastomycosis occurring 18 months after treatment of pulmonary blastomycosis in an immunocompetent child. Our patient was successfully treated sequentially with liposomal amphotericin B followed by oral voriconazole without need for surgical resection.