Spontaneous Regression of Metastatic Lesions of Adenocarcinoma of the Gastro-Esophageal Junction.

Spontaneous regression of cancer is a rarely recognized entity in modern medicine. Historically, this was recognized and hypothesized that an infection causes immune activation, indirectly stimulating the body to destroy tumor cells. Similarly, immune-oncology has now become a major modality in the treatment of solid and some liquid malignancies. However, now with improved therapeutic modalities in the oncology world, one does not get to appreciate our own immune system's ability to fight cancer. We present a patient who had spontaneous regression of metastatic adenocarcinoma of the gastroesophageal junction (GEJ). The patient is a 58-year-old female who had presented with early satiety and dysphagia for which she underwent esophagogastroduodenoscopy which showed an esophageal mass and endoscopic ultrasounds (EUSs) confirmed adenocarcinoma of the GEJ with metastasis to the regional lymph nodes and left supraclavicular lymph nodes. The patient had refused to undergo any surgical, medical oncological, or holistic treatments. Interim disease monitoring positron emission tomography-computed tomography (PET-CT) showed resolution of the metastatic sites of gastroesophageal cancer with clinical improvement of her symptoms. She continues to have this distant regression of metastatic gastroesophageal cancer six months after the initial diagnosis. In literature, spontaneous cancer regression has been reported in melanoma, renal cell carcinoma, and basal cell carcinoma. To our knowledge, this is the first case reported of spontaneous regression of metastatic lesions involving adenocarcinoma of the GEJ with no medical or surgical intervention.

Pembrolizumab - emerging treatment of pulmonary sarcomatoid carcinoma: A case report.

BACKGROUND: Few studies have addressed the efficacy of pembrolizumab in pulmonary sarcomatoid carcinoma (PSC), a rare, previously rapidly fatal subtype of non-small-cell lung cancer. CASE SUMMARY: We report the case of a 69-year-old man presented with respiratory distress caused by a large left upper lung lobe mass diagnosed as PSC with programmed death-ligand 1 expressed on more than 50 percent of tumor cells. The patient was started on pembrolizumab and, after 5 cycles, there was a more than 80 percent decrease in the size of the tumor mass. Further decrease was seen at the end of 10 cycles. The patient has been tolerating pembrolizumab well, with no limiting side-effects. Fourteen months after first coming into the hospital, he remains asymptomatic. CONCLUSION: Pembrolizumab appears as a viable emerging treatment for PSC.

Rare presentation of small bowel adenocarcinoma with neuroendocrine differentiation in the jejunum: A case report and summary of diagnostic and management options.

Cancer of the small bowel (SB) is rare. The most common SB malignancy is neuroendocrine, followed by adenocarcinoma. SB adenocarcinoma with overlapping neuroendocrine differentiation (NED) is very uncommon. The present case report discusses the case of a young African American female who presented with high-grade SB perforation and underwent urgent surgical repair. Histology of the tumor revealed jejunal adenocarcinoma with NED. To the best of our knowledge, this type of tumor has not yet been reported in the jejunum. Referring patients that present with insidious and nonspecific abdominal discomfort for imaging studies that are more sensitive to the SB could potentially identify tumors earlier, prevent the development of emergent gastrointestinal complications and offer a chance for cure. An overview of diagnostic tools for SB evaluation was provided.

Burkitt Lymphoma of the Duodenum: An Uncommon Phenomenon.

Burkitt lymphoma is an aggressively growing tumor commonly found in African children, involving the jaw and facial bones. Most non-Hodgkin lymphoma tumors involve extra nodal sites like the nervous system and gastrointestinal tract. A rare variant of this type of lymphoma is found in immunocompromised patients specifically in the gastrointestinal tract with accompanying gastrointestinal symptoms. Burkitt lymphoma is a malignancy that has commonly presented in GI tract but rarely in the duodenum. This clinical variant can commonly involve stomach, ileum, and cecum. However, there is very limited data available regarding the duodenal growth of this tumor. Duodenal involvement of Burkitt lymphoma is extremely rare and accounts for < 1% of all lymphomas. We present a case report of an older patient with a duodenal Burkitt lymphoma diagnosed by biopsy. A high suspicion should be present while treating immunocompromised patients with chronic abdominal symptoms especially with complications such as bleeding or occult positive testing. Early endoscopy intervention with biopsy can help identity and treat these conditions with improved outcomes for the patients.

Venetoclax and low-dose cytarabine induced complete remission in a patient with high-risk acute myeloid leukemia: a case report.

Conventional combination therapies have not resulted in considerable progress in the treatment of acute myeloid leukemia (AML). Elderly patients with AML and poor risk factors have grave prognosis. Midostaurin has been recently approved for the treatment of FLT-3-mutated AML. Venetoclax, a BCL-2 inhibitor, has been approved for the treatment of relapsed and/or refractory chronic lymphoid leukemia. Clinical trials on applying venetoclax in combination with cytarabine and other agents to treat various hematological malignancies are currently underway. Here, we present a case of a male patient with poor performance status and who developed AML following allogeneic hematopoietic stem cell transplant for high-risk myelodysplasia. The patient with high risk AML achieved complete response to the combined treatment regimen of low-dose cytarabine and venetoclax. Furthermore, we reviewed current clinical trials on the use of venetoclax for hematological malignancies.

Dasatinib-Induced CMV Hepatitis in an Immunocompetent Patient: A Rare Complication of a Common Drug.

Dasatinib is a common anticancer drug used in the treatment of leukemia. Several side effects have been reported, the most common being myelosuppression, diarrhea, edema, and nausea. Three papers have been published reporting hepatic side effects of dasatinib treatment. A rare side effect of dasatinib treatment is reactivation of latent cytomegalovirus (CMV) infection. Never before has dasatinib therapy shown to be the cause of CMV hepatitis in an immunocompetent patient. We present a case of an immunocompetent patient who was treated with the standard dose of dasatinib therapy and subsequently developed CMV hepatitis. Well-known side effects of dasatinib therapy are understood and documented; unknown adverse drug reactions can occur and should be monitored for. This is a significant finding given the high rate of CMV seropositivity in the general population.

Identification Bracelet Precipitated Acute Compartment Syndrome during Intravenous Infusion in an Obtunded Patient.

Acute compartment syndrome is a serious condition requiring immediate medical care. A lack of urgent medical treatment can result in serious complications such as loss of function and even amputation. While the pathophysiology of acute compartment syndrome is well understood, numerous potential causes are still being discovered. A rare cause of acute compartment syndrome is IV infiltration. We present a case of acute compartment syndrome resulting from intravenous infusion due to proximal placement of a patient identification bracelet. We conclude that both routine evaluation for IV infiltration and proximal placement of IV lines are essential for prevention of acute compartment syndrome.

The first documented case of hemorrhagic stroke caused by Group B streptococcal meningitis.

We report the case of a 47 year-old female with Streptococcus agalactiae (Group B beta-hemolytic streptococcus) meningitis complicated by hemorrhagic stroke. The patient presented to the emergency department with altered mental status, agitation, confusion, respiratory distress and fever of one-day duration. Labs showed left shift leukocytosis. CSF exhibited a high white blood cell count with a predominant population of polymononuclear cells, high glucose and protein concentration. CSF cultures grew S. agalactiae. Despite appropriate antimicrobial treatment, her mental status did not improve and head CT showed two hemorrhages, diffuse cerebral edema and a right to left midline shift. After completing the course of her therapy, her mental status improved and the patient was discharged.