Damoun Safarpour

A targetable androgen receptor-positive breast cancer subtype hidden among the triple-negative cancers.

CONTEXT Triple-negative breast cancer (TNBC) is a subgroup of breast cancers that by definition lack expression of estrogen receptor, progesterone receptor, and human epidermal growth factor receptor 2 (HER2). A diverse group of tumors, TNBC shares some morphologic and molecular features with basal-like breast cancer, a category of breast cancer defined by gene expression profiling. More likely to occur in young women and African Americans, TNBCs may exhibit aggressive behavior and are associated with poor prognosis despite their initial response to conventional chemotherapy. Because hormonal or HER2-targeted therapies are ineffective for these tumors, the main therapeutic option is systemic chemotherapy. Therefore, identification of new targets for therapy is urgently needed for this group. OBJECTIVE To review and present recent literature along with our own experience regarding the clinical and morphologic characteristics and the prevalence of androgen receptor (AR) expression in TNBC, and to discuss the potential use of AR as a therapeutic target for AR(+) TNBC. DATA SOURCES Data sources are published articles from peer-reviewed journals in PubMed (US National Library of Medicine). CONCLUSIONS AR is the most commonly expressed hormone receptor among all breast carcinomas, with a prevalence of 25% to 75% among TNBCs. Therefore, we strongly support the routine assessment of AR in TNBC, and preferably in all breast carcinomas.

Intramedullary metastasis in breast cancer--a comprehensive literature review.

BACKGROUND Intramedullary breast cancer metastasis (IMBCM) is considered rare but its true incidence is unknown. Previous reviews of this subject are few and provided limited information. OBJECTIVE To evaluate the precise location(s) of IMBCM, its concurrence rate with brain metastasis, its frequency compared to other cancers, intervals between breast cancer diagnosis and detection of IMBCM and between detection of IMBCM and death, frequency of various clinical symptoms, neuroimaging, cerebrospinal fluid (CSF) and biomarker data, treatment strategies and survival issues. STUDY DESIGN All relevant literature from 1900 to present was identified through Yale search Engine including but not limited to Medline/Pub Med, Ovid and Erasmus. RESULTS A total of 36 publications were identified describing 85 patients with IMBCM. Breast cancer was the second highest source of intramedullary metastasis after lung (26.5% versus 45%). Cervical and thoracic cord was equally affected. Presence of thoracic cord lesions (P=0.039), concurrent brain metastasis, bladder dysfunction and Brown-Sequard syndrome were associated with a more unfavorable prognosis. Treatment strategies which included surgery suggested prolonged survival. Patients with breast metastasis to the spinal cord had longer survival than lung metastasis (P=0.05). The data on CSF and tumor markers was too limited to be conclusive. CONCLUSIONS Introduction of Magnetic Resonance Imaging has significantly increased the detection rate of IMBCM. Factors associated with better prognosis are presented. Definition of the true incidence of IMBCM would require a prospective clinical and neuroimaging study.

Chorea Associated with High Titers of Antiphospholipid Antibodies in the Absence of Antiphospholipid Antibody Syndrome

Background Chorea associated with high titers of antiphospholipid antibodies in the absence of antiphospholipid antibody syndrome has been seldom reported. Case report An 89-year-old female developed persistent right side chorea associated with high titers of anticardiolipin antibody (antiphospholipid antibosies immunoglobulin (Ig)M, 45 MPL and 112 IgM aCL (MPL) after 3 months) but normal lupus anticoagulants. Her magnetic resonance imaging (MRI) showed no abnormality, but positron emission tomography (PET) demonstrated increased bilateral striatal metabolic activity, more on the left side. Her MRI showed no cause for chorea. The PET scan demonstrated a marked increase in the metabolic activity of the left basal ganglia. Discussion Her chorea remained unchanged over a 9-month follow-up period. The literature on chorea associated with high titers of antiphospholipid antibodies in the absence of antiphospholipid syndrome is reviewed.

Intermittent ascending muscle spasms and paraparesis associated with diffuse extradural meningeal cysts

Perineural cysts (Tarlov cysts) are caused by pathological expansion of the space between perineurium and endoneurium of the posterior spinal nerve roots and can be associated with dural ectasia and related syndromes (Marfan, Ehler-danlos, Loeys–Dietz Syndrome) and odontoid dysplasia [1]. We report an unusual patient in whom extensive, multi-level extradural meningeal cysts were associated with frequent intermittent disabling muscle cramps and at times with ascending paralysis.