Prevalence of Cancer in Rheumatoid Arthritis: Epidemiological Study Based on the National Health and Nutrition Examination Survey (NHANES).

Rheumatoid arthritis (RA) is a multi-system autoimmune disease with significant morbidity and healthcare burden. It is an inflammatory condition and has been associated with lymphomas, with or without the presence of immunosuppressive therapy. However, the association of rheumatoid arthritis with other malignancies has been inconsistent. We used the data from a population-based National Health and Nutrition Examination Survey (NHANES) for epidemiological study to evaluate the association between RA and the incidence of cancer. Using the data collected between 2011 and 2014, we were able to determine the incidence of cancer in 11,262 patients. Incidence of cancer was increased in patients with RA with an odds ratio of 1.632 (95% confidence interval [CI]: 1.239-2.151; p=0.0005). Breast cancer (CA) and prostate CA were the most common types of cancer (each diagnosed in 16.22% individuals) and lung CA and lymphomas found in 1.35% of individuals. It is also important to be aware of increased risk and adequately screen patients for malignancies during the course of treatment and follow up of rheumatoid arthritis. Further large prospective studies are required to determine the association of the RA or its treatment and the risk of malignancies.

Clinically Silent Intracardiac Metastasis with Extremely Poor Prognosis in a Patient with Hepatocellular Carcinoma.

Intracavitary cardiac extension remains an unusual site of extrahepatic metastasis in patients with hepatocellular carcinoma. While patients can present with signs and symptoms suggestive of right-sided heart failure, it may be totally asymptomatic, which is very rare with only a few cases reported so far. Also, cardiac metastasis is of great prognostic importance as patients with intracardiac metastasis can have an extremely poor prognosis. Here, we present the case of a 52-year-old male patient with advanced hepatocellular carcinoma, with an incidentally found tumor thrombus extending from the inferior vena cava to the right atrium, protruding through the tricuspid valve into the right ventricle, on routine echocardiography. The patient did not have any signs or symptoms of heart involvement and unfortunately died on the 18th day of the hospital stay.