Solitary fibrous tumor/hemangiopericytoma (SFT/HPC) is a rare intracranial tumor that arises from pericytes surrounding the blood vessels. Solitary fibrous tumor/hemangiopericytoma accounts for less than 1% of primary brain tumors and is classified as grades I, II, or III based on mitotic count. These tumors often masquerade as meningiomas. Histologically, SFT/HPC is vascular with high cellularity and often surrounded by connective tissue. Immunohistochemistry is positive for stat 6, vimentin, and CD34. Although aggressive surgical resection is the mainstay of treatment, close long-term follow-up is necessary as recurrence or extra cranial metastasis can present several years after resection.
Extramedullary myeloma (EMM) is an infrequent but well-established manifestation of multiple myeloma (MM), defined as a soft tissue plasma cell neoplasm without bone marrow involvement. Gallbladder involvement in EMM, however, is a very rare occurrence, with only 8 cases found in the English medical literature. Here, we present a case of an older adult male with a gallbladder mass in the presence of increasing serum kappa light chains after a normal bone marrow biopsy confirmed the complete remission of a previous MM diagnosis. Histopathologic evaluation of a biopsied sample confirmed the mass as an atypical plasma cell neoplasm. Later in his treatment, he developed several firm, smooth, violaceous skin nodules on the torso, which histopathology confirmed as also being atypical plasma cell neoplasms. We aim to contribute to the medical literature by expanding the pool of information regarding EMM of the gallbladder to support future diagnostic and treatment recommendations.
64 Background: Colorectal cancer (CRC) screening has shown to improve early detection and reduce mortality. Despite, the availability of multiple screening tests for CRC, the current screening rates remains below the national goal. The multi-target stool (MTS) DNA test (commercially known as Cologuard) has contributed to an increase in population adherence to CRC screening and is currently recommended by multiple guidelines. Southeastern Kentucky (SE KY) has a high incidence of colorectal cancer and a low rate of CRC screening. The aim of this study is to assess the adherence to the MTSDNA test in rural SE KY. Methods: A retrospective review of all patients 45 and older with a MTSDNA test ordered between August 2020 and February 2021 at a large primary care group in SE KY. All patients had Tests ordered and kits delivered. Cross-sectional adherence was defined as completion and return of the kit within 180 days from test order and was assessed as overall adherence and by patient characteristics including age, sex and healthcare coverage. Results: 450 tests were ordered. 160 (35%) were male and 290 (65%) females. Mean age was 62 with age range (46-87). 207 tests were returned with a cross-sectional adherence of 46%. Adherence was significantly lower for age 45 - 55 at 35.2% (26.2-45.2) compared to age 55 - 65 at 48.9% (40.9-56.3), 65 and older at 50.0% (42.3-57.7) (P = 0.04). Highest adherence with Medicaid coverage 65.4% [44.3-82.8] and lowest in Managed Care Organization (MCO) coverage 34.0% [4.7-44.2] (P < 0.01). Gender was not associated with adherence (P = 0.75). Conclusions: This retrospective study showed that only 46% of patients were adherent to the MTS DNA test for colorectal screening which is significantly lower than previously reported in larger studies and further studies are needed to identify the barriers to non-adherence to this test, especially in the younger population with alarming increase in incidence of CRC. There is impending need to implement different strategies to improve screening adherence.
Colorectal adenocarcinoma (CRC) most commonly metastasizes to the peritoneum, liver, lung, and bone. Metastasis to the oral cavity is uncommon. Here, we report the case of a 74-year-old man who presented with a few months of chewing and swallowing difficulty, shoulder pain, and weight loss of 30 pounds. On oral exam, he was noted to have a 5 cm fixed hard palate mass. Primary hard palate malignancy was initially suspected. Biopsy of the mass confirmed adenocarcinoma with an immunohistochemical pattern suggestive of colorectal origin. He was later found to have extensive skeletal metastasis. Palliative radiotherapy to the hard palate region was initiated, followed by palliative systemic chemotherapy. We have found only three other published cases of rectal adenocarcinoma with hard palate metastasis.
Introduction: Pancreatic lymphoma comprise less than 1 % of pancreatic malignancies. Most common location of diffuse large B cell lymphoma (DLBCL) are lymph nodes. Clinical symptoms and imaging studies have significant similarity resulting in delayed diagnosis or early initiation of comfort care measures. It is important to determine the histology of pancreatic tumor given the differences in management and prognosis. Here we report a rare case of primary DLBCL arising from pancreas. Case Description/Methods: 62-year-old female with history of HTN and DM presented with 30 lbs unintentional weight loss epigastric abdominal pain and early satiety. CT abdomen with IV and oral contrast demonstrated pancreatic mass. Core biopsy of pancreatic head mass demonstrated infiltration by large atypical lymphoid cells with high N/C ratio, round nuclear contour, fine chromatin and variably prominent nucleoli (Figure A). Atypical mitosis and apoptosis seen in background. Lymphoma cells positive for CD 19, CD 20 (Figure B). Final diagnosis Large B cell lymphoma germinal center type. FISH for BCL 2, C MYC were normal ruling out possibility of double or triple hit lymphoma. Cancer antigen 19-9 at the time of diagnosis was within normal limits. FDG PET/CT prior to initiation of treatment showed main foci of increased tracer activity appears to be in the proximal body of the pancreas just medial to the stomach, measures greater than 4 cm in diameter, and has a maximum SUV of 11.86 (Figure C). Rituximab- Cyclophosphamide HydrOxyadriamycin Prednisone (R-CHOP) every 3 weeks initiated. After one cycle of R-CHOP reported significant improvement in epigastric pain and started gaining weight. She completed 6 cycles of R-CHOP. Post treatment FDG PET/CT complete resolution of upper abdominal lymph node mass (Figure D). She remains in remission for the past 1 year. Discussion: Our case is an example of successful biopsy and treatment with aim to cure pancreatic malignancy. Despite radiological differences between pancreas adenocarcinoma and lymphoma, it is crucial to obtain adequate tissue sampling during from pancreas to establish histological diagnosis prior to discussion of prognosis and treatment plan. In general, DLBCL germinal center type has a 5-year survival of 70% with R-CHOP. Differential diagnosis of pancreatic mass that confer better prognosis than adenocarcinoma include neuroendocrine tumor, solid pseudopapillary tumor and lymphoma. Therefore, it is important to obtain biopsy and direct therapy based on histology.Figure 1.: A: Core biopsy of pancreatic head mass demonstrated infiltration by large atypical lymphoid cells with high N/C ratio, round nuclear contour, fine chromatin and variably prominent nucleoli. B: Lymphoma cells positive for CD 19, CD 20. C: FDG PET/CT prior to initiation of treatment showed main foci of increased tracer activity appears to be in the proximal body of the pancreas just medial to the stomach, measures greater than 4 cm in diameter, and has a maximum SUV of 11.86. D: Post treatment FDG PET/CT complete resolution of upper abdominal lymph node mass.
