Adrienne B. Gropper

Metastatic basal cell carcinoma of the posterior neck: case report and review of the literature.

Although primary basal cell carcinoma (BCC) represents an extremely common malignancy, metastases derived from BCC are exceedingly rare. The prognosis for metastatic BCC is poor, and little consensus exists regarding predictive factors or optimal treatment strategies. Here, we present the case of a 63‐year‐old man with BCC of the neck who subsequently developed multiple metastases to subcutaneous tissue, lymph nodes, and the parotid gland. Risk factors and clinical features of metastatic BCC are reviewed, as is the relationship of histopathologic subtype to metastatic behavior. Current chemotherapeutic and targeted therapies also are discussed in the context of recent advances in molecular biology.

Schistosomiasis haematobium prevalence and risk factors in a school-age population of peri-urban Lusaka, Zambia.

Given association of the parasite Schistosoma haematobium with coastal and rural/agricultural populations, there is little documentation to date of infection patterns in todays rapidly urbanizing non-coastal regions. We conducted an observational study of 5-17-year-old school children (N = 1583) in peri-urban compounds of Lusaka, Zambia. Demographic information, medical history, physical examination findings and urinalysis results were recorded. Prevalence of schistosomiasis in the population was 20.72%. Significant risk factors for infection were male gender [odds ratio (OR) 2.42], age of 9-12 years or 13-17 years (OR 3.33 and 3.26, respectively, compared with 5-8-year-olds) and single and/or double orphan status (OR 1.43). Clinical officers detected schistosomiasis with a sensitivity of 24.70% and a specificity of 98.17% after history and physical examination. These results reveal that peri-urban populations have a significant but under-recognized vulnerability to infection, and suggest that only history and physical examination are inadequate for identifying a treatment population.

Long-Term Follow-Up After Preoperative Trastuzumab and Chemotherapy for HER2-Overexpressing Breast Cancer

BACKGROUND Neoadjuvant chemotherapy and trastuzumab is an established treatment for locally advanced HER2-positive breast cancer, providing favorable rates of clinical response and pCR. Minimal data describe long-term outcomes after neoadjuvant HER2-directed therapy. This study aimed to explore long-term efficacy and toxicity after neoadjuvant trastuzumab and chemotherapy for HER2-positive breast cancer. PATIENTS AND METHODS Eligible patients participated in 1 of 2 single-arm phase II neoadjuvant trials, receiving either paclitaxel/trastuzumab (TH) or vinorelbine/trastuzumab (NH) for stage II-III HER2-positive disease. Postoperative chemotherapy, with or without trastuzumab, was offered. Charts were reviewed to identify recurrence, death, and treatment-related toxicities. Association of long-term outcomes with baseline characteristics and pathological response to primary therapy was explored. RESULTS Eighty patients were identified; 33 (41.3%) received TH and 47 (58.8%) received NH. Fourteen (17.5%) had pCR at surgery. Most (96.3%) received anthracycline-based adjuvant chemotherapy; 78.7% of NH patients also received adjuvant trastuzumab. At a median follow-up of 8.8 years, 23 (28.8%) patients have experienced recurrence, with 16 breast cancer-related deaths. Four-year RFS in patients with pCR was 92.9% (95% confidence interval [CI], 79.4%-100%) versus 72.4% without pCR (95% CI, 63.9%-82.1%). All initial symptomatic cardiotoxicity resolved during extended follow-up. New symptomatic cardiotoxicity in long-term follow-up was rare, primarily occurring in patients requiring retreatment with a cardiotoxic agent. CONCLUSION Neoadjuvant chemotherapy and trastuzumab for HER2-positive breast cancer resulted in favorable long-term survival with minimal late toxicity. Trends in this data set suggest an association between pCR and improved long-term RFS. Retreatment with cardiotoxic agents might increase risk of late cardiotoxicity.