Mucoepidermoid carcinoma, a salivary gland tumor, rarely occurs in bronchial mucous glands. Brain metastases are rarely seen which makes for a challenging diagnosis and treatment approach. A 40-year-old woman presented with confusion, and ataxia, accompanied by a declining Glasgow Coma Score. Brain computerized tomography revealed two hyperdense, postcontrast-enhanced infra- and supratentorial lesions with perifocal edema. First causing obstructive hydrocephalus. The initial surgery involved external ventricular drainage system placement leading to the patient\'s clinical improvement. After radiological diagnostics, both lesions were resected without complications. Histopathological analysis revealed solid clusters of atypical, polygonal epithelial cells exhibiting mucin production, classified as a poorly differentiated mucoepidermoid carcinoma metastasis which originated from the upper lobe\'s apicoposterior segment and left lung. The correct treatment approach remains elusive due to the infrequent occurrence and challenging diagnosis. While new oncological and radiosurgery options promise improved overall survival rates, radical resection remains the preferred initial option.

UNASSIGNED: We report a case of metastatic human epidermal growth factor receptor-2 (HER2) positive breast cancer who achieved encouraging clinical benefits across multiple pyrotinib-based anti-HER2 therapies.
UNASSIGNED: A 33-year-old woman was diagnosed with hormone receptor (HR) positive, HER2-positive breast cancer in June 2018, and did not receive adjuvant radiotherapy, chemotherapy, or anti-HER2 targeted therapy post-breast conserving surgery. By May 2020, she developed recurrence of the left breast mass with metastases in liver, bone and lymph nodes. She then received pyrotinib plus trastuzumab and nab-paclitaxel as first-line therapy. Both the left breast mass and liver metastases showed noticeable improvement, with the disease evaluated as partial response (PR). Despite this promising result, the patient developed brain metastases after first-line treatment. A combination regimen of pyrotinib retention plus inetetamab and vinorelbine were administered as second-line anti-HER2 therapy, and the brain metastases visibly shrunk, leading to PR, with the extracranial lesions remaining stable. Ultimately, due to brain lesions progression, the treatment was transitioned to trastuzumab deruxtecan. We applied next generation sequencing (NGS) to illustrate the efficacy of anti-HER2 therapy and minimal residual disease (MRD) to detect the disease status.
UNASSIGNED: Pyrotinib is a promising antineoplastic agent for HER2-positive advanced breast cancer patients. Under the guidance of precision medicine, it is encouraged to utilize novel diagnostic and therapeutic methods to manage advanced breast cancer patients.

The presence of lymph node metastases in prostate adenocarcinoma is a poor prognostic sign, and mortality rates are often high. Inguinal lymph node metastases are an unusual presentation of advanced disease, and they can be easily misinterpreted with other diseases. We present a case of a 63-year-old patient with no previous symptoms and signs of prostate disorder with a right-sided inguinal lump and abdominal pain. The CT scan showed right inguinal and retroperitoneal lymphadenopathy. Elevated PSA serum levels, digital rectal examination, and skeletal scintigraphy with 99mTc-MDP favored the diagnosis of metastatic prostate adenocarcinoma. Since the patient denied prostate biopsy, a dissection of the right inguinal nodes was performed. Histopathological findings confirmed metastatic prostate adenocarcinoma. The treatment was hormonal and bisphosphonate therapy, with objective posttreatment improvement. Based on this case, it can be concluded that inguinal and generalized lymphadenopathy are potential initial manifestations of metastatic prostate adenocarcinoma in male patients.

Spinal tuberculosis usually presents as destroyed contiguous vertebral bodies associated with intervertebral discs and paravertebral or psoas abscesses. Atypical forms are uncommonly reported. Vertebral involvement without disk destruction is a rare form that improves satisfactorily after appropriate medical management. We report the case of a 36-year-old male who had spine tuberculosis without disk involvement, associated with intercurrent active pulmonary location with good clinical improvement after treatment and follow-up imaging showing spectacular regression of bone lesions. By reporting this case, we also review the literature on this rare form of tuberculosis.

Small-cell carcinoma of the bladder (SCCB) is an uncommon and aggressive malignancy of the urinary tract. Its clinical presentation often mimics that of other bladder neoplasms, posing a diagnostic challenge. This case report presents a rare instance of SCCB in a 65-year-old female, shedding light on the diagnostic journey and emphasizing the need for heightened and prompt clinical suspicion due to its aggressive nature. The patient presented to the urological department with hematuria, dysuria, and hypogastric pain. Initial investigations revealed a bladder mass, prompting biopsies with inconclusive results. A comprehensive histopathological examination, including immunohistochemistry, confirmed a SCCB. A computed tomography (CT) scan was used to evaluate local and distal extention. Following the initial evaluation, a referral to an oncological service was needed. Diagnoses encompassed SCCB, with interventions that comprise chemotherapy without radical cystectomy. Despite the rarity of SCCB, timely and accurate diagnosis facilitated a tailored multidisciplinary approach, leading to prompt clinical oncology management. This case demonstrates the importance of meticulous diagnostic evaluation in rare malignancies, guiding individualized therapeutic strategies for optimal patient outcomes.

Isocitrate dehydrogenase mutant gliomas generally have a better prognosis than their wild-type counterpart. Recurrences are generally within the radiation field in the primary tumoral bed. Remote recurrence is uncommon and is usually intraparenchymal. Transformation to a higher grade has been observed with TP53 mutants. Presentation of glioma as an extra-axial lesion is extremely uncommon. No such cases of remote intracranial extra-axial recurrence have been reported in the literature. We describe the unique imaging findings in this case and attempt to formulate possible diagnoses. Intraoperative and pathological findings confirmed this unusual recurrence pattern.

Metastatic choriocarcinoma during viable pregnancy is rare worldwide, and neonate survival following pregnancy termination in the second trimester is uncommon. Here, we report the successful delivery of a pregnancy by a patient with metastatic choriocarcinoma, who received three courses of etoposide, methotrexate, actinomycin D, cyclophosphamide, and vincristine (EMA-CO) chemotherapy in the second trimester. After multidisciplinary discussions, she was administered paclitaxel and carboplatin (TC) chemotherapy. Regular contractions occurred during her first paclitaxel infusion, and a healthy infant was delivered by cesarean section at 26+4 gestational weeks. Choriocarcinoma was not detected in the placenta. Following delivery of the pregnancy, the patient underwent total treatment comprising one cycle of TC, seven cycles of EMA-CO, and five courses of etoposide, cisplatin, methotrexate, and dactinomycin chemotherapy; her serum level of beta-human chorionic gonadotropin gradually fell after chemotherapy. Uterine and pulmonary metastases shrank, and no distant metastasis or recurrence were found until the eighth course of maintenance treatment with immunotherapy. The patient received periodic chemotherapy for recurrence at the time of publishing this case report. The child was disease-free 15+ months after delivery. Despite serious metastases and complications, metastatic choriocarcinoma diagnosed in the second trimester of pregnancy can be successfully treated with minimal delay by multidisciplinary medical and nursing management.

Wilms tumor (WT) is the most common renal malignancy of childhood. The common metastatic sites are the lungs, liver, and lymph nodes, with brain and bone metastases occurring rarely. Metastatic disease can be present at initial diagnosis or may occur with relapse or disease progression. The majority of relapses in WT occur within the first two years post-treatment. Late relapses are rare. This article describes four cases of WT, each demonstrating an unusual site or timing of metastases. Case 1 presented primarily with jaw metastases, Case 2 presented with bone (vertebrae) and spinal metastases manifesting as paraplegia, at relapse one year after completion of treatment, Case 3 presented with isolated liver metastases four years after treatment completion, and Case 4 presented with brain metastases after six weeks of treatment abandonment. This case series demonstrates the varied pattern of metastases of WT and highlights the need for a high index of suspicion for WT among patients who present with unusual sites of tumor or for metastasis in those who present with neurologic symptoms during or after treatment.

Objective: Nasopharyngeal melanoma is a rare mucosal malignant melanoma with high recurrence rate, metastasis rate and vascular invasion rate. In this paper, we report a case of primary nasopharyngeal mucosal melanoma. Methods: A case of primary nasopharyngeal mucosal melanoma was reported, and its clinical symptoms, pathological characteristics, treatment and follow-up were described in detail. Results: This report describes a 59-year-old male patient with persistent nasal congestion and suspected malignant nasopharyngeal neoplasm. Patients receive surgical resection and adjuvant radiotherapy after complete resection. Imaging studies showed no tissue invasion or lymph node metastases. The results of immunohistochemistry were Melan-A(+), HMB45(+), and S100(+). The final diagnosis was malignant nasopharyngeal melanoma. After 2 years of follow-up, the prognosis was good, and there was no metastasis or recurrence. Discussion: Nasopharyngeal melanoma is a rare malignancy with a poor prognosis, and surgical resection is the mainstay of treatment. Postoperative adjuvant therapy can improve the rate of local control of lesions. Early diagnosis and thorough examination are extremely important for the patient\'s prognosis.

Background: Agmination and/or satellitosis in pigmented blue lesions is a phenomenon rarely mentioned in the literature and not well known. This phenomenon can be expressed by several benign and malignant pigmented blue lesions, such as blue nevi, Spitz nevi, melanocytoma and melanoma. On this spectrum, dermoscopy, reflectance confocal microscopy (RCM) and dynamic Optical coherence tomography (D-OCT) represent non-invasive imaging technologies, which may help clinicians in the diagnosis of melanoma and non-melanoma skin cancers in daily clinical practice. Methods: Currently, in the literature there is a lack of new data about agminated blue lesions and blues lesions with satellitosis, as well as the lack of a recent and updated review of the literature about this topic. Therefore, considering that clinicians must be confident with the diagnosis of these rare skin lesions, we decided to carry out this work. Results: In this paper, four new cases of agminated pigmented cutaneous lesions were described. Moreover, a review of the current literature on this topic was performed. Conclusions: A clinical-pathological correlation is often needed to reach a correct diagnosis; currently, dermoscopy and non-invasive diagnostic techniques, such as reflectance confocal microscopy and optical coherence tomography, due to the depth of these skin lesions in the dermis, can only make a partial and limited contribution.