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A 58-year Caucasian woman with a 45-pack year smoking history underwent a computed tomography (CT) scan of the chest due to a persistent respiratory infection. Imaging revealed extensive mediastinal and hilar lymphadenopathy on the right. Fine needle aspiration of the right paratracheal and subcarinal lymph nodes revealed small cell lung carcinoma. She was treated with definitive concurrent chemoradiation (with Cisplatin and Etoposide) therapy to the primary tumor and the mediastinum using intensity modulated radiation therapy. Post-treatment repeat CT of the chest showed complete radiographic response and she was offered prophylactic cranial irradiation which the patient refused. Within six months of completing treatment, the patient developed brain metastases and was treated with a course of palliative radiation to the whole brain. One month after completion, she noticed painful swelling of the left submandibular gland and a CT showed an enlarged submandibular gland. FNA revealed metastatic SCLC. She was treated with urgent palliative RT to the left submandibular gland with significant improvement in her symptoms. [ABSTRACT FROM AUTHOR]

Introduction: Multiple endocrine neoplasia 1 (MEN1) is a cancer syndrome resulting from mutations of the MEN1 gene. The syndrome is characterized by neoplasia of the parathyroid and pituitary glands, and malignant tumors of the endocrine pancreas. Other manifestations include benign lipomas, angiofibromas, and carcinoid tumors commonly originating in the colon, thymus, and lung. This is the first report of MEN1 syndrome manifesting as bilateral granulosa cell ovarian tumors, and which is associated with a rare intronic mutation of the MEN1 gene. Case report: A 41-year-old woman presented with abdominal pain, increasing abdominal girth, and dysmenorrhea. Ultrasound demonstrated enlarged ovaries and uterine fibroids. After an exploratory laparotomy, she subsequently underwent bilateral salpingo-oophorectomy with hysterectomy where the pathology revealed bilateral cystic granulosa cell tumors of the ovaries. Additional workup including computed tomography imaging discovered a thymic mass, which the pathology showed was malignant, along with a pancreatic mass suspicious for a neuroendocrine tumor. Hyperparathyroidism was also discovered and was found to be secondary to a parathyroid adenoma. Genetic testing revealed an exceedingly rare mutation in the MEN1 gene (c.654 + 1 G>A). Discussion: Mutations of the menin gene leading to MEN1 syndrome are classically nonsense or missense mutations producing a dysfunctional protein product. Recently, researchers described a novel mutation of MEN1 (c.654 + 1 G>A) in a male proband meeting the criteria for clinical MEN1 syndrome. Functional analysis performed on the stable mutant protein showed selective disruption of the transforming growth factor beta signaling pathway, yet it maintained its wildtype ability to inhibit nuclear factor kappa B and to suppress JunD transcriptional activity. Conclusion: To our knowledge, this is the first report of MEN1 syndrome associated with bilateral granulosa cell malignancy. We postulate that this presentation may be due to the novel menin gene mutation recently described. [ABSTRACT FROM AUTHOR]

ObjectMetastasis to the thyroid gland is a rare event.MethodsWe describe an unusual case of a 38-year-old woman with a history of small-cell lung cancer (SCLC), presenting with a new nodule in the thyroid gland, found to be metastatic SCLC, without evidence of widespread dissemination.ConclusionsA new thyroid nodule should be carefully evaluated for metastasis in a patient with a history of prior malignancy. [ABSTRACT FROM AUTHOR]

Background: To report the clinical and treatment outcome of patients with lacrimal gland lymphoma (LGL) treated with radiation therapy (RT) at Fox Chase Cancer Center, Philadelphia, PA, USA. Materials and Methods: Institutional review board approved retrospective chart review of eight patients and literature review. Results: The study patients included six males and two females with a mean age of 70 years (range 58-88 years). The mean follow-up period was 23 months (range 3-74 months). Four patients had mucosa-associated lymphoid tissue (50%) lymphoma and four patients had other non-Hodgkin's lymphoma variants. Four patients had bilateral disease (50%). Four patients had primary LGL (stages I-IIAE, 50%) and four had LGL as part of systemic lymphoma (stage IVAE, 50%). The median RT dose was 2987 cGy (range 2880- 3015 cGy). All patients had complete response to RT with symptomatic relief. Minimal dry eye was seen in all patients. There were no late effects such as corneal ulcer, radiation retinopathy, maculopathy, papillopathy, or secondary neovascular glaucoma. Conclusions: RT alone is an extremely effective treatment in the curative management of localized LGL and provides durable, local control of secondary LGL. [ABSTRACT FROM AUTHOR]

Purpose: To correlate tumor oxygenation status with long-term biochemical outcome after prostate brachytherapy. Methods and Materials: Custom-made Eppendorf Po 2 microelectrodes were used to obtain Po 2 measurements from the prostate (P), focused on positive biopsy locations, and normal muscle tissue (M), as a control. A total of 11,516 measurements were obtained in 57 men with localized prostate cancer immediately before prostate brachytherapy was given. The Eppendorf histograms provided the median Po 2, mean Po 2, and % <5 mm Hg or <10 mm Hg. Biochemical failure (BF) was defined using both the former American Society of Therapeutic Radiation Oncology (ASTRO) (three consecutive raises) and the current Phoenix (prostate-specific antigen nadir + 2 ng/mL) definitions. A Cox proportional hazards regression model evaluated the influence of hypoxia using the P/M mean Po 2 ratio on BF. Results: With a median follow-up time of 8 years, 12 men had ASTRO BF and 8 had Phoenix BF. On multivariate analysis, P/M Po 2 ratio <0.10 emerged as the only significant predictor of ASTRO BF (p = 0.043). Hormonal therapy (p = 0.015) and P/M Po 2 ratio <0.10 (p = 0.046) emerged as the only independent predictors of the Phoenix BF. Kaplan-Meier freedom from BF for P/M ratio <0.10 vs. ≥0.10 at 8 years for ASTRO BF was 46% vs. 78% (p = 0.03) and for the Phoenix BF was 66% vs. 83% (p = 0.02). Conclusions: Hypoxia in prostate cancer (low mean P/M Po 2 ratio) significantly predicts for poor long-term biochemical outcome, suggesting that novel hypoxic strategies should be investigated. [ABSTRACT FROM AUTHOR]