Journal of Cancer & Allied Specialties <p>The <em>Journal of Cancer &amp; Allied Specialties </em>is a double blind peer-reviewed open access electronic journal which focuses on all aspects of <em>cancer care</em>.</p> en-US <p>Authors retain copyright and grant the Journal of Cancer &amp; Allied Specialties (JCAS) right-of-first publication. In addition, the work will be simultaneously licensed under a <a href="">Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International license</a>. This license allows others to share the work in whole or part (for non-commercial purpose), with an acknowledgement of the work’s authorship and initial publication in JCAS.</p> <p>Furthermore, authors are free to enter into separate contractual arrangements for the non-exclusive distribution of the journal’s published version of the work, with an acknowledgement of its initial publication in this journal.</p> <p>Authors are permitted and encouraged to share their work online or in medical or scientific conferences prior to or during submission process.</p> (Khawaja S. Nasir) (Ms Sana Qamar) Sat, 08 Jan 2022 04:13:42 -0800 OJS 60 A Case of Esophageal Squamous Papilloma, an Unusual Cause of Dysphagia and Hematemesis in a Patient with Concurrent Malignancies <p><strong>Introduction: </strong>The oesophageal squamous papilloma (ESP) is a rare cause of dysphagia and hematemesis. The malignant potential of this lesion is uncertain; however, the malignant transformation and concurrent malignancies have been reported in the literature. <strong>Case description</strong>: We report a case of oesophageal squamous papilloma in a 43-year-old female who had a background diagnosis of metastatic breast cancer and liposarcoma of the left knee. She presented with dysphagia. Upper gastrointestinal (GI) endoscopy showed a polypoid growth, and its biopsy confirmed the diagnosis. Meanwhile, she presented again with hematemesis. A repeat endoscopy showed that the previously seen lesion had likely broken off, leaving behind a residual stalk. This was snared and removed. The patient remained asymptomatic, and a follow-up upper GI endoscopy at six months did not show any recurrence. <strong>Practical implications:</strong> To our knowledge, this is the first case of ESP in a patient with two concurrent malignancies. Moreover, the diagnosis of ESP should also be considered when presenting with dysphagia or hematemesis.</p> Muhammad Saqib, Muhammad Zeeshan Siddique, Jhanzeb Iftikhar, Shafqat Mehmood, Muhammed Aasim Yusuf Copyright (c) 2022 Muhammad Saqib, Muhammad Zeeshan Siddique, Jhanzeb Iftikhar, Shafqat Mehmood, Muhammed Aasim Yusuf Thu, 21 Oct 2021 00:00:00 -0700 Primary Prostatic Diffuse Large B-Cell Lymphoma: a Case Report and Literature Review <p><strong>Introduction:</strong> Primary lymphomas of the prostate are globally rare representing less than 0.1% of all prostatic neoplasms. In this paper we present a case of an early stage diffuse large B-cell lymphoma (DLBCL) of the prostate managed with six cycles of rituximab-based chemotherapy, and review the related literature. <strong>Case description:</strong> A 32-year-old man presented to our clinic with complaints of difficult urination and perineal pain. An enlarged, hard and nodular prostate was palpable on digital rectal examination. Needle biopsy of the prostate was performed, which revealed diffuse large B-cell non-Hodgkin's lymphoma by immunohistochemical studies. CT scan showed large pelvic mass arising from prostate encasing ureters with bilateral hydronephroureter. &nbsp;No abnormal finding was seen on abdominal CT and bone marrow histology. Therefore, the disease was classified into the clinical stage IAXE according to Ann Arbor's criteria. The patient achieved complete response (CR) to six cycles of rituximab based combination chemotherapy, R-CHOP with CNS prophylaxis. He remained disease free, until now, 36 months after the end of chemotherapy. <strong>Practical Implications:</strong> According to the literature, the treatment and prognosis of primary lymphoma of the prostate is the same as that of other nodal lymphomas. Rituximab-based regimen should be considered in the management of prostatic diffuse large B-cell lymphoma.</p> Samia Yasmeen, Waqas Ahmad, Omer Waqas, Abdul Hameed Copyright (c) 2022 Samia Yasmeen, Waqas Ahmad, Omer Waqas, Abdul Hameed Thu, 16 Dec 2021 00:00:00 -0800 Unusual Presentation of Treated Colon Cancer with Extramural Venous Invasion: a Case Report <p><strong>Introduction</strong>: Colon cancer is one of the leading malignancies globally and continues to be one of the most typical causes of cancer-related mortality. The clinical outcome of the disease depends on the primary tumor stage, regional nodal involvement, and distant disease dissemination. It often presents with hematogenous spread to the liver at the time of diagnosis. Another factor for increased mortality is the presence of extramural venous invasion (EMVI). This is exceedingly important as it has significant prognostic significance and helps predict survival. <strong>Case Description: </strong>A middle-aged female with a recent history of cesarean delivery presented with abdominal pain and occasional constipation, which led to a series of investigations. Initial Computed Tomography (CT) scan showed proximal to mid transverse colonic tumoral thickening with locoregional lymphadenopathy and solitary distant metastasis in the left hepatic lobe. This was followed by extended right hemicolectomy and hepatic metastasectomy. &nbsp;The patient remained on follow-up and later presented with thrombus formation in the splenoportal circulation. Initially, this was considered a bland thrombus, and the patient was advised a close follow-up. However, the patient was lost to follow and later presented with extensive thrombosis of the portal and splenic veins. <strong>Practical Implications: </strong>Confident differentiation of the bland versus malignant thrombosis is crucial to ascertain disease stage and appropriate management. Invasive tissue sampling gives a confident diagnosis of benign versus malignant thrombus. However, using a noninvasive imaging modality, we can still distinguish between the two with reasonable certainty.</p> Ainy Javed, Afaque Ali, Kashif Siddique, Iqra Zainab Copyright (c) 2022 Afaque Ali Mon, 20 Dec 2021 21:51:46 -0800 Presentation of Acute Lymphoblastic Lymphoma and Colorectal Carcinoma in the Context of Constitutional Mismatch Repair Deficiency Syndrome (CMMRD): a Case Report with Literature Review <p><strong>Introduction: </strong>Constitutional mismatch repair deficiency (CMMRD) is a rare autosomal recessive disease-carrying an increased risk of cancers (pediatric tumors of central nervous system, haemato-lymphoid malignancies along with gastrointestinal (GI) cancer(s), which are usually seen in the second and third decade) leading to syndromic presentation. Causal mutations are detected in DNA mismatch repair (MMR) genes, including MLH1, PMS2, MSH2, and MSH6 that are also known for their established role in Lynch syndrome. We describe a case of CMMRD with an earlier (first decade of life) presentation of mediastinal acute lymphoblastic lymphoma and colorectal malignancy. <strong>Case Presentation</strong>: A five-year-old boy presented with respiratory complaints, bilateral cervical lymphadenopathy, multiple café au lait macules (CALMs) on the lower back, history of parental consanguinity with the death of three sisters due to brain tumor within 6 months of diagnosis. Computerized tomographic (CT) scan chest revealed a huge mediastinal mass. The patient underwent a trucut-biopsy of the mass. The results were significant for a pre T-cell acute lymphoblastic lymphoma. Suspicion of CMMRD was raised based on a combination of factors described above. A panel of mismatch repair (MMR) proteins was applied on the biopsy tissue that revealed loss of nuclear expression of MLH1 and PMS2 immunostaining in tumor cells with positive external controls. While on maintenance therapy for lymphoma, about a year later, the patient developed sub-acute intestinal obstruction due to a stenosing polypoidal circumferential tumor in the mid-sigmoid colon found on flexible sigmoidoscopy that was followed by endoscopic biopsies and insertion of a fully-covered self-expanding metallic adult biliary stent with a diameter of 10 mm and length of 6 cm leading to immediate relief of obstruction. Biopsies revealed adenocarcinoma with neuroendocrine differentiation. Metastatic tumor deposits were seen in the omentum, anterior abdominal wall, and the left peritoneal wall. <strong>P</strong><strong>ractical Implications</strong>: Earlier (first decade) presentation of gastrointestinal malignancy warrants that an earlier screening through radiological scans for any possible tumors and MMR protein expression analysis (loss in tumor plus normal non-tumor cells) are essential in patients having CALMs and family history of pediatric tumors.</p> Muhammad Irfan Basheer, Iftikhar Ali Rana, Umer Nisar Sheikh, Muhammed Aasim Yusuf, Irfana Ishaq Sindhu, Asif Loya Copyright (c) 2022 Muhammad Irfan Basheer, Iftikhar Ali Rana, Umer Nisar Sheikh, Muhammad Aasim Yusuf, Irfana Ishaq Sindhu, Asif Loya Mon, 20 Dec 2021 22:47:18 -0800 Infantile T-cell Acute Lymphoblastic Leukemia: a Case Report <p><strong>Introduction</strong>: Acute lymphoblastic leukemia (ALL) is the most common malignancy in children, with a male predominance. Pediatric acute lymphoblastic leukemia is usually of B-cell lineage; T-cell leukemia is uncommon and extremely rare under one year of age. Mixed-lineage leukemia gene rearrangement is the best-known hallmark of infantile leukemia and is a poor prognostic indicator. While multi-agent high dose chemotherapy remains the first line of treatment for pediatric T-ALL, there are numerous side effects of these regimens, and most patients undergo relapse. Due to the rarity of the disease, treatment protocols for infantile T-ALL have not been established to date. <strong>Clinical description:</strong> We present a case of a 7-month-old Pakistani male that presented with fever and cough and was subsequently diagnosed with T cell acute lymphoblastic leukemia. T-ALL was diagnosed on flow cytometry. Due to poor prognosis, the patient was assigned palliative care. <strong>Practical implications:</strong> Management of infantile leukemia has yet to be studied in-depth. With a lack of clear treatment guidelines, the approach towards these patients remains challenging. Further research and clinical trials in this area of study are paramount to improving clinical outcomes for these young patients.</p> Natasha Baig, Sadia Muhammad, Sumaira Shaikh Copyright (c) 2022 Natasha Baig, Sadia Muhammad, Sumaira Shaikh Wed, 22 Dec 2021 23:40:25 -0800 Secondary Trigeminal Neuralgia: a Case Report and Literature Review of Red Flags <p><strong>Introduction: </strong>Trigeminal neuralgia (TN) is characterized by recurrent paroxysmal brief episodes of electric shock-like pain along the trigeminal nerve distribution. Based on the underlying cause, current classification systems have classified TN into idiopathic, classical, and secondary TN. This manuscript presents a case report of a patient seen in the clinic with features of trigeminal neuralgia secondary to an intracranial lesion. <strong>Case description: </strong>A 39-year-old female presented to the clinic with a 15-month history of severe, intermittent, short-lasting episodes of pain affecting the left lower teeth, jaw, nose, and temporal region. The patient reported familiar shock-like pain during the physical examination when the skin of the left ala of the nose was lightly touched. The rest of the clinical examination was non-significant. The magnetic resonance imaging of the brain showed an approximately 20 mm wide lesion at the level of the cerebellopontine angle. After subsequent tests, the lesion was diagnosed as meningioma, and the patient was treated with stereotactic radiation therapy.<strong> Practical Implications: </strong>In up to 10 % of TN cases, the underlying cause can be due to a brain tumor. Although persistent pain, sensory or motor nerve dysfunction, gait disturbances, and other neurological signs may concurrently exist, raising a red flag for intracranial pathology, patients often present with pain alone as the heralding symptom of a brain tumor. Due to this, it is imperative that all patients suspected of having TN undergo an MRI of the brain as part of the diagnostic work-up.</p> Khawaja Shehryar Nasir, Muhammad Atif Naveed Copyright (c) 2022 Khawaja Shehryar Nasir, Muhammad Atif Naveed Wed, 29 Dec 2021 00:55:49 -0800