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Zalecenia dotyczące oceny immunoekspresji białek MMR i p53 oraz zapisu wyników w rozpoznaniach patomorfologicznych u chorych z rakiem endometrium — stanowisko ekspertów klinicznych i patomorfologicznych
No full textThe rare co-occurrence of cholangiocarcinoma and chronic eosinophilic leukemia
No full textIntroduction. Cholangiocarcinoma (CCA) is a rare and highly aggressive malignancy of the bile ducts with a poor prognosis and a 5-year survival rate of approximately 5%. Chronic eosinophilic leukemia (CEL), characterized by clonal eosinophil proliferation, is a rare hematologic malignancy often progressing to acute leukemia. The simultaneous occurrence of these two malignancies is exceedingly rare, according to available research, this is the first case reported in the literature.
Case report. This is the case of a 44-year-old female presenting with fatigue, diagnosed with metastatic CCA following imaging and biopsy. During chemotherapy with gemcitabine and cisplatin, the patient developed unexplained leukocytosis and eosinophilia, leading to a subsequent diagnosis of CEL. Despite aggressive treatment, the patient experienced complications, including cholangitis and renal failure, and succumbed to her illness four months post-diagnosis.
Conclusions. This case highlights the rare co-occurrence of CCA and CEL, emphasizing the importance of vigilant monitoring for secondary hematologic malignancies in oncology patients. Early recognition and treatment of concurrent disorders can improve clinical outcomes and inform future research on such rare malignancy combinations
Silent enemy in the spinal cord: rare tumors that surprise doctors
No full textPrimary spinal cord tumors represent a heterogeneous group of CNS neoplasms that, due to their location, pathological diversity, and nonspecific clinical presentation, remain a significant diagnostic and therapeutic challenge. The rarity of these tumors results in limited epidemiological data, and knowledge of their natural history, treatment methods, and prognosis. This paper provides an overview of the current state of knowledge on rare primary spinal cord tumors, with particular attention to epidemiological, pathological, clinical characteristics, and available diagnostic and therapeutic strategies. The role of advanced imaging techniques, such as magnetic resonance imaging (MRI), computed tomography (CT), and additional tests, is emphasized. The importance of pathological examination as a key element in establishing an accurate diagnosis and further treatment planning is highlighted. The current therapeutic approach is also evaluated, taking into account the role of surgical treatment, radiation therapy, and chemotherapy. Special attention is paid to the necessity of conducting treatment in interdisciplinary specialist teams, allowing for individualization of therapy and increasing the chances of improving patient prognosis. The existing limitations in the treatment of these tumors, arising from both their location and their pathological structure are also discussed
Oral mucositis pain management — an overview of current guidelines and clinical approaches
No full textOral mucositis (OM) is a painful complication of cancer treatments, particularly in patients receiving radiotherapy for head and neck cancers or undergoing stem cell transplants. The pain often requires opioids for relief, but current Multinational Association of Supportive Care in Cancer and the International Society of Oral Oncology (MASCC/ISOO) guidelines offer limited recommendations due to insufficient research and varying study methods. This review explores OM pain management, focusing on MASCC/ISOO guideline-based recommendations and other strategies not yet included. Opioids like morphine are the most effective treatments, with topical morphine suggested in some cases. However, other treatments, including transdermal fentanyl and doxepin mouthwash, lack sufficient evidence for inclusion in the guidelines. Most available treatments focus on preventing OM or reducing its duration rather than directly managing pain. Some procedures, such as cryotherapy and photobiomodulation, show promise, with photobiomodulation also providing potential pain relief. Until more research is available, clinicians should follow the World Health Organization (WHO) analgesic ladder, tailor pain management to individual patients, and refer to updated MASCC/ISOO guidelines for optimal care
Leukocytoclastic vasculitis with purpura induced by panitumumab
No full textIntroduction. Panitumumab is a fully human monoclonal antibody that specifically targets the epidermal growth factor receptor (EGFR). It is used in the treatment of metastatic colorectal cancer (mCRC) in patients with RAS wild-type tumors. Dermatological toxicities occur in approximately 90% of patients receiving panitumumab, with severe cases reported in 15% of patients. In rare instances, severe vasculitis has also been associated with its use.
Case report. A 51-year-old male patient with metastatic colorectal cancer and KRAS wild-type status presented with palpable purpura and petechiae. Ten days after receiving five cycles of FOLFOX in combination with panitumumab, the patient developed purpuric lesions on both lower extremities. A skin biopsy of these lesions confirmed a diagnosis of leukocytoclastic vasculitis. During the sixth treatment cycle, panitumumab was withheld, and the patient received only mFOLFOX-6, leading to lesion regression. Panitumumab-induced leukocytoclastic vasculitis was considered as the likely cause.
Discussion. This case is notable as petechiae and purpura are rare dermatological toxicities associated with panitumumab. A definitive diagnosis of leukocytoclastic vasculitis was confirmed through skin biopsy. The lesions responded well to oral corticosteroids and topical treatment, leading to resolution. Subsequently, the patient’s metastatic colorectal cancer treatment continued without panitumumab.
When infection dissects the heart: An unusual case of infective endocarditis with extensive structural damage
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