BACKGROUND Squamous cell carcinoma is one of the most common keratinocytic skin cancers, the other being basal cell carcinoma. It is the second most common skin cancer after melanoma. Cutaneous ...squamous cell carcinoma is mostly a localized disease. The metastatic presentation is rare even in the presence of invasive disease. The metastatic potential depends on the presence of high-risk features at the time of diagnosis. Lung, liver, and bone are the frequent sites of metastasis. Local and locoregional disease undergoes excision with or without adjuvant radiation. However, we lack proper treatment paradigms for this metastatic disease. CASE REPORT We are reporting a case of an elderly female with a history of high-risk localized cutaneous squamous cell carcinoma treated with complete local excision and radiation presenting 5 years later with extensive disease to the lung and liver, abdominal nodes, and spinal fracture. The patient was not a candidate for chemotherapy due to kidney failure. On the basis of ongoing separate trials on different immunotherapies, she was started on nivolumab. CONCLUSIONS Treating metastatic cutaneous squamous cell carcinoma is a challenge considering the absence of phase III trials due to the rarity of this disease. Historically, platinum with or without 5-FU (fluorouracil), bleomycin, doxorubicin, and retinoic acid were used with variable responses. Data on epidermal growth factor receptor (EGFR) inhibitors on EGFR expressing tumors are available. However, even with the most recent reports on immunotherapy in patients with high programmed death-1 expression or high mutation burden, it is difficult to achieve good response.
BACKGROUND Primary pulmonary diffuse large B cell lymphoma (DLBCL) is extremely rare neoplasm representing only 0.5-1% of primary pulmonary malignancies. These patients usually have non-specific ...clinical presentation and radiological findings. Therefore, it is important to increase awareness of this rare disease, as the correct characterization of the tumors will have therapeutic and prognostic implications. CASE REPORT We present the case of a middle-aged Hispanic woman with chronic cough and an abnormal chest X-ray revealing a lung mass, who was found to have primary pulmonary DLBCL. She underwent 6 cycles of R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone) therapy and attained complete remission. CONCLUSIONS With its non-specific presentation, the diagnosis of primary pulmonary DLBCL is very challenging and often leads to misdiagnosis or delayed diagnosis. The pathogenesis of primary pulmonary DLBCL is still poorly understood. The choice of treatment approach should be based on the biological characteristic of the tumor, stage, and performance status.
Strong lenses are extremely useful probes of the distribution of matter on galaxy and cluster scales at cosmological distances, but are rare and difficult to find. The number of currently known ...lenses is on the order of 1,000. We wish to use crowdsourcing to carry out a lens search targeting massive galaxies selected from over 442 square degrees of photometric data from the Hyper Suprime-Cam (HSC) survey. We selected a sample of \(\sim300,000\) galaxies with photometric redshifts in the range \(0.2 < z_{phot} < 1.2\) and photometrically inferred stellar masses \(\log{M_*} > 11.2\). We crowdsourced lens finding on this sample of galaxies on the Zooniverse platform, as part of the Space Warps project. The sample was complemented by a large set of simulated lenses and visually selected non-lenses, for training purposes. Nearly 6,000 citizen volunteers participated in the experiment. In parallel, we used YattaLens, an automated lens finding algorithm, to look for lenses in the same sample of galaxies. Based on a statistical analysis of classification data from the volunteers, we selected a sample of the most promising \(\sim1,500\) candidates which we then visually inspected: half of them turned out to be possible (grade C) lenses or better. Including lenses found by YattaLens or serendipitously noticed in the discussion section of the Space Warps website, we were able to find 14 definite lenses, 129 probable lenses and 581 possible lenses. YattaLens found half the number of lenses discovered via crowdsourcing. Crowdsourcing is able to produce samples of lens candidates with high completeness and purity, compared to currently available automated algorithms. A hybrid approach, in which the visual inspection of samples of lens candidates pre-selected by discovery algorithms and/or coupled to machine learning is crowdsourced, will be a viable option for lens finding in the 2020s.
BACKGROUND Double-hit lymphomas (DHL) belong to a category of very aggressive lymphomas characterized by MYC translocation and either BCL2, or less commonly, BCL6 translocations. Those with BCL6 ...translocations have a predilection for rare extranodal sites such as the gastrointestinal tract, nasopharynx, and tonsils. Involvement of the skull and adnexal structures is rare. Here we report a case of a young female with both skull and adnexal involvement. CASE REPORT A 20-year-old female who presented with hypercalcemia was found to have adnexal, skull, and jaw masses. Workup revealed a stage IV high grade B-cell lymphoma (HGBL) with MYC and BCL6 rearrangements. She was subsequently treated with R-EPOCH and attained complete remission 9 months after her initial presentation. To the best of our knowledge, our patient represents the first reported case of skull and adnexal involvement in HGBL with MYC and BCL6 rearrangement. CONCLUSIONS Rare extranodal presentations of HGBL with MYC and BCL6 rearrangement should be considered in the differential diagnosis of masses found in unusual sites such as the skull and adnexa. Due to their aggressive nature, early and prompt recognition of these lymphomas is essential for timely administration of appropriate therapy.
BACKGROUND Extranodal natural killer/T-cell lymphoma, nasal type (ENKTCL) is generally an aggressive and rare non-Hodgkin lymphoma. It is most common in East Asians, Native Americans, and South ...Americans, but is rarely reported in blacks. CASE REPORT A 55-year-old African American male born in Grenada presented with a left nostril mass with facial swelling and biopsy subsequently confirmed a diagnosis of extranodal NK/T-cell lymphoma, nasal type (ENKTCL). Immunochemistry was positive for CD2, cytoplasmic CD3, CD7, CD 43, CD 56, granzyme B, and TIA-1. In situ hybridization was positive for Epstein-Barr virus encoded ribonucleic acid (EBERs). Bone marrow aspiration did not show lymphoma involvement. The patient had progressive neutropenia upon presentation, with further investigations showing hepatomegaly, hyperferritinemia, and hemophagocytosis in the bone marrow. We reached a diagnosis of hemophagocytic syndrome. He was treated with a high-dose combination chemotherapy and radiation therapy; the neutropenia improved significantly with steroids as treatment for immune activation in the setting of hemophagocytic syndrome. CONCLUSIONS To the best of our knowledge, this is the only second report of extranodal NK/T-cell lymphoma, nasal type in a black patient, and it raises the awareness of early recognition of rare manifestations of NK/T-cell lymphoma such as hemophagocytic syndrome.
Context. Strong lenses are extremely useful probes of the distribution of matter on galaxy and cluster scales at cosmological distances, however, they are rare and difficult to find. The number of ...currently known lenses is on the order of 1000. Aims. The aim of this study is to use crowdsourcing to carry out a lens search targeting massive galaxies selected from over 442 square degrees of photometric data from the Hyper Suprime-Cam (HSC) survey. Methods. Based on the S16A internal data release of the HSC survey, we chose a sample of ∼300 000 galaxies with photometric redshifts in the range of 0.2 < zphot < 1.2 and photometrically inferred stellar masses of log M* > 11.2. We crowdsourced lens finding on this sample of galaxies on the Zooniverse platform as part of the Space Warps project. The sample was complemented by a large set of simulated lenses and visually selected non-lenses for training purposes. Nearly 6000 citizen volunteers participated in the experiment. In parallel, we used YATTALENS, an automated lens-finding algorithm, to look for lenses in the same sample of galaxies. Results. Based on a statistical analysis of classification data from the volunteers, we selected a sample of the most promising ∼1500 candidates, which we then visually inspected: half of them turned out to be possible (grade C) lenses or better. By including lenses found by YATTALENS or serendipitously noticed in the discussion section of the Space Warps website, we were able to find 14 definite lenses (grade A), 129 probable lenses (grade B), and 581 possible lenses. YATTALENS found half the number of lenses that were discovered via crowdsourcing. Conclusions. Crowdsourcing is able to produce samples of lens candidates with high completeness, when multiple images are clearly detected, and with higher purity compared to the currently available automated algorithms. A hybrid approach, in which the visual inspection of samples of lens candidates pre-selected by discovery algorithms or coupled to machine learning is crowdsourced, will be a viable option for lens finding in the 2020s, with forthcoming wide-area surveys such as LSST, Euclid, and WFIRST.
Published reports from France and Norway suggest a frequent incidence of anaphylaxis to rocuronium and have raised concerns about its safety. We hypothesized that the Food and Drug Administration ...Adverse Event Reporting System could be used to confirm whether there has been an unusual incidence of anaphylactic events for rocuronium in the United States (U.S.) and whether the reporting patterns differ within and outside of the U.S.. We queried the Food and Drug Administration Adverse Event Reporting System for 1999 through the first quarter of 2002 for all adverse events for the drugs rocuronium and vecuronium and then searched on the terms considered to represent possible anaphylaxis using proprietary software. We compared the frequency of these terms in data both for rocuronium and vecuronium. We then assessed the occurrence of reports of anaphylaxis-related terms in reports from the U.S. compared with reports originating outside of the U.S.. For rocuronium, the database contained 311 reports, 166 domestic and 145 from foreign sources. Fifty percent of the foreign reports contained an anaphylaxis term versus 20% of the domestic reports (P < 0.001). For vecuronium, the comparable figures were 17% and 19% (not significant) and the total number of reports was 243. The incidence of the reports containing anaphylaxis terms did not differ between vecuronium and rocuronium in the U.S. but were significantly different for foreign reports (P < 0.001). These data confirm that U.S. anesthesia providers have not observed a significant difference in anaphylactic reactions between the two commonly used intermediate-acting muscle relaxants and suggest that frequency of reports of anaphylaxis may be significantly influenced by the area from which the reports originate.
Thirty-two patients with AIDS and previously untreated cytomegalovirus retinitis completed an induction course of foscarnet, 60 mg/kg every 8 h for 14 days, had retinitis stabilize, and were then ...randomly assigned to receive foscarnet maintenance as either a 90- or 120-mg/kg/day infusion administered over 2 h. Median survival was 157 and 336 days for the 90- and 120-mg/kg/day groups, respectively (P < .001). In an independent, masked analysis of retinal photographs, median time to progression ofretinitis was 31 versus 95 days (P = .13). Daily intravenous foscarnet at a dose of 120 mg/kg (adjusted for renal function) resulted in significantly longer survival and tended to increase time to retinitis progression compared to the standard 90-mg/kg/day maintenance dose. Although a substantial increase in the risk of serious toxicity at the 120-mg/kg/day dose was not observed, the small sample size in this trial limited the power to detect differences that might be clinically important.
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