RESUMO
Tumor thrombus (TT) is a complication of renal cell carcinoma (RCC) for which favorable medical management remains undefined. While radical nephrectomy has been shown to increase overall survival in RCC patients, surgical interventions such as cardiopulmonary bypass (CPB) and deep hypothermic circulatory arrest (DHCA) utilized to perform TT resection carry high mortality rates. While it has been documented that RCC with TT is associated with venous thromboembolism (VTE) development, anticoagulation use in these patients remains controversial in clinical practice. Whether anticoagulation is associated with improved survival outcomes remains unclear. Furthermore, if anticoagulation is initiated, there is limited evidence for whether direct oral anticoagulants (DOACs), heparin, or warfarin serve as the most advantageous choice. While the combination of immunotherapy and tyrosine kinase inhibitors (TKIs) has been shown to improve the outcomes of RCC, the clinical benefits of this combination are not well studied prospectively in cases with TT. In this literature review, we explore the challenges of treating RCC-associated TT with special attention to anticoagulation. We provide a comprehensive overview of current surgical and medical approaches and summarize recent studies investigating anticoagulation in RCC patients undergoing surgery, targeted therapy, and/or immunotherapy. Our goal is to provide clinicians with updated clinical insight into anticoagulation for RCC-associated TT patients.
RESUMO
Primary mediastinal seminomas are exceedingly rare tumors, often localized to the anterior mediastinum. They may present with numerous complications, including superior vena cava syndrome, chylothorax, and pericardial effusions. Less commonly, they may present with paraneoplastic encephalitis. In this report we describe a case of a 19-year-old male with no significant past medical history who presented with bilateral hearing loss, progressive neuropathy, and ataxia. Subsequently the patient was found to have mediastinal mass with a high-titer anti-Hu antibody. To our knowledge, only one other case of mediastinal seminoma presenting with anti-Hu antibodies has been described in the literature. In this report, we describe a rare case of mediastinal seminoma, describe treatment options, and discuss additional known cases presenting with paraneoplastic encephalitis.
RESUMO
Low-grade fibromyxoid sarcoma (LGFMS) is a rare subclass of sarcoma. Histologically, they are characterized by bland-appearing fibroblastic spindle cells and are similar to sclerosing epithelioid fibrosarcoma (SEF) subtype. The standard treatment of this aggressive tumor subtype is surgical removal with wide excision in conjunction with doxorubicin chemotherapy. Due to the rarity of this disease, effective systemic therapies are lacking and patient outcomes remain poor. Herein, we report on a 50-year-old male who presented with severe shortness of breath. Subsequent imaging revealed pericardial effusion and large mediastinal mass consistent with locally advanced disease. Fine needle biopsy demonstrated malignant, Ewing-like round tumor cells. Further genetic analysis affirmed the presence of FUS-CREB3L2 gene fusion. The patient was treated with doxorubicin and survival time from the initial presentation was five months. To date, there are limited reports of this disease. Few targeted therapies or immunotherapies for LGFMS exist, and a dire need for new therapy development remains.
