Shweta Gupta

Tumor Lysis Syndrome in Multiple Myeloma: An Increasingly Recognized Risk—A Report of Seven Cases

Abstract Tumor lysis syndrome is a constellation of metabolic disturbances commonly seen during therapy of bulky, rapidly proliferative tumors. Multiple myeloma is a low proliferation tumor with rare incidence of tumor lysis syndrome in the pre-Bortezomib era. Post Bortezomib use, a rise in the incidence of tumor lysis has been noted. We present seven cases of tumor lysis syndrome with three patients in spontaneous tumor lysis and four developing the same after chemotherapy. In the previous studies, elevated LDH and deletion of chromosome 13 has been associated with risk of TLS. In our study, we noted several abnormal karyotpes including del 9p13, del 17 and monosomy 13 were more frequently found but larger studies are needed to explore the causative nature of these associations. Prognosis in these patients is relatively poor reflecting the higher tumor burden. However, further studies are needed to learn about other poor prognostic markers.

Metastasis of cervical cancer to breast: A case report and review of literature

Metastasis to the breast from an extra-mammary malignancy has been documented in literature, however cervical cancer metastasis to the breast is very rare. Thirty-eight cases of metastatic deposit to the breast from cervical cancer have been reported in literature. Though most patients present with a breast lump, it is very difficult to clinically distinguish a primary breast malignancy from a metastatic deposit. Histopathology of the tissue, aided with immune-histochemical staining pattern provides a definitive diagnosis. Our patient, a 51-year old woman presented with breast lump and history of post-menopausal bleeding. Upon further workup, the patient was diagnosed with cervical cancer. The mammogram and ultrasound of the breast showed multiple lumps within the breast. Histopathology of the breast mass showed metastatic deposit in the breast from cervical cancer. The patient was treated with radiation therapy to the cervix along with concurrent chemotherapy for local control of pain. After completion of local treatment, she started systemic chemotherapy, however she developed health-care associated pneumonia and subdural hematoma leading to deterioration in her performance status. The patient opted for hospice care and died 2 months later. In this report, we will review the presentation of the 38 cases reported in literature and the imaging and histopathologic findings of metastatic deposits to the breast.

Stroger Hospital of Cook County (CCH) AIDS malignancy project: The CHAMP study—A 13-year, single institution retrospective study of cancers in patients infected with HIV.

1551 Background: CCH is the largest health provider for HIV patients in Chicago and has one of the largest HIV outpatient clinics in the United States, the Ruth M. Rothstein CORE Center (CC). Per year, over 5000 HIV + individuals are treated at the CC with over 500 HIV-infected individuals treated at CCH. Most studies of non-AIDS defining (NADC) and AIDS defining cancers (ADC) cover wide areas. Insights into the prevalence, type of cancer, and characteristics of HIV + cancer patients found in the inner city and underserved populations have been under represented in the literature. To this end, we examined all of the malignancies presenting to either the CC or CCH for the past 13 years. METHODS We identified via CCH, CC, and pharmacy databases all HIV infected patients with a cancer ICD9 codes from 1998-2010. HIV characteristics, cancer type, and patient demographics were confirmed by chart review. One-way Anova was used to show statistical significant between the prevalence among the different sub populations. RESULTS After initial screening, 404 cancers were confirmed, representing 21 malignancies. 56% were ADC, with 104 (25%) non-hodgkins lymphoma (NHL), 111(28%) Kaposi sarcoma, and 11(2.7%) cases of cervical cancer. Of the 104 NHL, the most common were DLBCL 61%, Burkitts (BL) 21%, and primary CNS lymphoma 7.6%. The most frequent NADC was anal cancer (n=30) and Hodgkin lymphoma (n=29). 70% of all cancers were stage III or above. HIV + patients at the CC were 71% African American (AA) and 19% Hispanic (Hsp) (compared to 26% and 23% in the Chicago population, respectively). In our study, AA represents 64% of all HIV cancers with Hsp and Caucasians 17% each. Though Caucasians with HIV and cancer in our cohort have the highest prevalence of cancer, 1.06%, vs. 0.69% AA vs. 0.60 Hsp (P< 0.001). The Male:Female ratio of all HIV malignancies in our cohort are 5.1:1. CONCLUSIONS Our data show a race disparity isolated to AA compared to the general population, and a male predominance. Although the Caucasian-HIV population is the smallest, they have the highest cancer prevalence.