Garrett R. Lynch

Elevated Plasma Chromogranin-A Concentrations in Prostatic Carcinoma

Chromogranin-A is considered a sensitive immunohistochemical tissue marker in neuroendocrine prostatic carcinoma. We report that the plasma chromogranin-A level was elevated in 48% of 25 patients with stage D2 prostate cancer, and suggest that this marker can be used to monitor the clinical course of these patients.

Caregiver symptom burden: the risk of caring for an underserved patient with advanced cancer.

The growing diversity of the population of the United States and the high burden of cancer‐related symptoms reflect the need for caregiver research within underserved groups. In this longitudinal study, the authors assessed changes in symptom severity in caregivers and underserved minority patients diagnosed with advanced solid tumors who were being treated at public hospitals.

Intralesional interferon-α and zidovudine in epidemic Kaposi's sarcoma

Background: Kaposis sarcoma (KS) is the most common neoplasm in patients with acquired immunodeficiency syndrome (AIDS). To date, no therapy has proved to be consistently effective. Objective: The purpose of this study was to evaluate the efficacy of intralesional interferon- α in patients with epidemic KS who were taking zidovudine. Methods: Up to five lesions in each of 14 patients entered into the study were injected with 1 million U of interferon- α three times weekly for 6 weeks. Sterile water was used as a placebo control. The median zidovudine dose was 500 mg/day. The median CD4 count was 23/ μ l. Results: Of 14 patients evaluated, 13 of 14 (93%) showed a clinical complete response (CR) or partial response (PR) to therapy. Of 54 lesions injected, 41 (76%) showed a CR and 5 (9%) showed a PR, which resulted in an overall response rate of 85%. Conclusion: Intralesional interferon- α produced a high response rate in injected lesions of KS, but it failed to demonstrate superior efficacy over the placebo.

Levels of Symptom Burden During Chemotherapy for Advanced Lung Cancer: Differences Between Public Hospitals and a Tertiary Cancer Center

PURPOSE We compared risk factors for high disease- and treatment-related symptom burden over 15 weeks of therapy in medically underserved patients with advanced non-small-cell lung cancer and in patients treated at a tertiary cancer center. PATIENTS AND METHODS We monitored symptom severity weekly during chemotherapy. Patients were recruited from a tertiary cancer center (n=101) and three public hospitals treating the medically underserved (n=80). We used a composite symptom-severity score and group-based trajectory analysis to form two groups: one with consistently more severe symptoms and another with less severe symptoms. We examined predictors of group membership. RESULTS Seventy percent of the sample (n=126) reported low symptom-severity levels that decreased during therapy; 30% (n=55) had consistently severe symptoms throughout the study. In multivariate analysis, patients with good performance status being treated in public hospitals were significantly more likely than patients treated at the tertiary cancer center to be in the high-symptom group (odds ratio, 5.6; 95% CI, 2.1 to 14.6; P = .001) and to report significantly higher symptom interference (P = .001). Other univariate predictors of high-symptom group membership included variables associated with being medically underserved (eg, having less education, being single, and being nonwhite). No group differences by ethnicity were observed in the public hospitals. Medically underserved patients were less likely to receive adequate pain management. CONCLUSION Patients with advanced lung cancer and good performance status treated at public hospitals were more likely than those treated at a tertiary cancer center to experience substantial symptoms during chemotherapy.

Monitoring of Cisplatin Ototoxicity by Distortion-Product Otoacoustic Emissions

Cisplatin is one of the most commonly used chemotherapeutic agents. However, ototoxicity, in particular, damage to the outer hair cells of the cochlea, is one of its major side effects. Otoacoustic emissions are acoustical signals that originate from the contractile activity of the outer hair cells. They are transmitted from the cochlea to the external ear canal via the middle ear apparatus. Testing is quick, painless, objective, and non-invasive. Distortion-product otoacoustic emissions (DPOAEs) are one of the evoked types of otoacoustic emissions. They are quite sensitive to any insult to the outer hair cells, even before damage is manifested in pure tone audiometry (PTA). A patient, who was on cisplatin chemotherapy due to prostate cancer, was monitored periodically for ototoxicity using DPOAEs and PTA. DPOAEs were found to detect ototoxicity one course of chemotherapy earlier than PTA during cisplatin chemotherapy. The clinical application and sensitivity of DPOAEs in monitoring ototoxicity were discussed.

Small-cell carcinoma of the ovary: An aggressive epithelial cancer occurring in young patients

A case of small-cell carcinoma of the ovary occurring in a 33-year-old patient is described. At no time did the patient develop hypercalcemia. Despite aggressive cytoreductive surgery and multiagent chemotherapy, the patient expired after 13 months. These lesions must be differentiated from germ cell tumors or lymphoma. Review of the literature fails to reveal effective adjuvant therapy.

Subcutaneous fat necrosis as the presenting feature of a pancreatic carcinoma: the challenge of differentiating endocrine and acinar pancreatic neoplasms.

The association between pancreatic panniculitis and pancreatic disease is well described, but differentiation among the neoplastic causes of the syndrome remains difficult due to substantial overlap in histological and immunohistochemical features. We report a case of subcutaneous fat necrosis as the presenting feature in a 61-year-old man with metastatic carcinoma of pancreatic origin. Previous pathological evaluation of the patients liver biopsy led to an initial diagnosis of adenocarcinoma of unknown primary site. One month later, the patient presented with pancreatic panniculitis, prompting further investigation. Immunohistochemistry was consistent with neuroendocrine differentiation, but the patient rapidly decompensated and died before the evaluation was complete, leaving the definitive diagnosis in question. In our review of the published reports of tumor types associated with pancreatic panniculitis, we found that immunohistochemical staining and electron microscopy can and should be used in conjunction with clinical correlation to accurately differentiate neuroendocrine tumors from carcinomas with acinar cell features. Accurate diagnosis of these tumors is necessary to determine prognosis and define appropriate therapy.

AIDS-related Kaposi's sarcoma involving bone and bone marrow

AIDS-related Kaposis sarcoma rarely involves bone or bone marrow. Computed tomography of the abdomen and pelvis of an AIDS patient with lower back pain and bilateral limb edema revealed multiple lesions involving liver, spleen, and axial skeleton. Bone marrow examination of the involved iliac crest revealed Kaposis sarcoma. Pathologic diagnosis is important so that appropriate treatment can be prescribed.

Postradiation Squamous Cell Cancer of the Breast

Abstract Primary squamous cell carcinoma of the breast is a rare clinical entity. We diagnosed a patient who presented with a pure squamous cell cancer of the breast 12 years after local radiation for a primary adenocarcinoma of breast. Previously reported cancers related to radiation of the breast have been squamous cell of skin and esophagus and sarcomas, especially angiosarcomas, and on literature review this is the first reported case of primary squamous carcinoma of the breast related to previous radiation. Although our observation suggests a possible link, no established cause and effect relationship is known at this point.

Hypercalcemia of advanced malignancy: decision making and the quality of death.

Hypercalcemia is a common complication of certain advanced malignancies and although not therapeutically difficult, its presence raises complex ethical issues. Treatment of this condition is most easily justified when the patient is not terminal, the benefits are tangible, and the patient agrees with therapy. Withholding treatment is defensible medically, legally, and morally when a terminal situation is present, when drawbacks exceed the benefits, and when an informed patient declines therapy. Hypercalcemia is one of a number of conditions of dying that can be controlled by the physician. The physicians decision to treat such a condition, in part, depends upon his or her view of a good death. Further study is needed to clarify and avoid those situations of dying which involve suffering. Physicians must begin this difficult analysis and dialogue if they are to fulfill their obligation to minimize suffering in all patients.