BACKGROUND: The simplified Pulmonary Embolism Severity Index (sPESI) has limitations when evaluating acute pulmonary embolism (PE) in patients with concurrent malignancy. Despite its utility in predicting outcomes among cancer patients, the role of the Eastern Cooperative Oncology Group Performance Status (ECOG PS) in acute PE remains underexplored. This study aims to assess the prognostic significance of ECOG PS ≥ 3 on short- and long-term mortality in acute PE with malignancy, correlating it with the sPESI.
RESULTS: We retrospectively analyzed 44 hemodynamically stable acute PE patients with unresectable or metastatic malignancies ineligible for curative treatment at Kameda Medical Center, a tertiary medical facility in Japan, from April 1, 2019, to March 2, 2023. Of these patients, 16 (36.4%) had ECOG PS ≥ 3. No 30-day mortality occurred in patients with ECOG PS ≤ 2, compared to 18.8% in those with ECOG PS ≥ 3 (p = 0.04). Groups were similar in the sPESI scores, hospital-onset PE proportion, and initial treatments. Post PE diagnosis, 92.9% of ECOG PS ≤ 2 patients and 50% of ECOG PS ≥ 3 patients received chemotherapy (p = 0.002). Cox regression analysis revealed ECOG PS ≥ 3 was independently associated with increased overall survival hazard (adjusted HR = 4.0; P = 0.002).
CONCLUSIONS: ECOG PS ≥ 3 suggests a poorer short-term prognosis and independently predicts a worse long-term prognosis in hemodynamically stable acute PE patients with advanced malignancies.

UNASSIGNED: Malignant tumors of the ureteric bud are not common, and cervical involvement is even rarer. So far, there have been no such cases in the literature.
UNASSIGNED: A 50-year-old woman developed intermittent light bleeding in the past 7 months and lower abdominal pain in the past 2 months. The human papillomavirus 16 (HPV) DNA, P16 chemical staining, thinPrep cytology test (TCT), and cervical and cervical canal tissue biopsy were all negative. Pelvic color Doppler ultrasound exhibited incomplete mediastinal uterus and heterogeneous echo from the cervical canal to the posterior wall of the cervix. Pelvic contrast-enhanced CT showed left cervical mass, left retroperitoneal mass, absence of the left kidney, and mediastinal uterus. An increase in human epididymal protein 4 (HE4) (133.6 pmol/L) was detected, while other tumor markers were at normal levels. Based on these examination results, a diagnosis of \"cervical fibroids, left retroperitoneal mass, incomplete mediastinal uterus, left kidney deficiency\"[SIC] was conducted, and expanded hysterectomy, right adnexectomy, and left retroperitoneal mass resection were performed. Through intraoperative rapid pathological diagnosis, postoperative pathological diagnosis combined with the re-evaluation of laboratory, and imaging and intraoperative examination results, the patient was diagnosed with ureteric bud intestinal-type adenocarcinoma involving the cervix. The patient has been tracked and followed up for approximately 11 months. She underwent six courses of chemotherapy. At present, the medication has been discontinued for 4 months, and there is no recurrence, metastasis, or deterioration of the tumor.
UNASSIGNED: For large masses of the cervix, it is feasible for the operation to be performed, improving the prognosis. There were a few limitations. A preoperative aspiration biopsy of masses was not performed to differentiate benign from malignant. Preoperative urography was not performed to clarify the function of the malformed urinary system structure. Partial cystectomy should be performed simultaneously with the resection of the ureteric bud for intestinal-type adenocarcinoma. In this case, a partial cystectomy was not performed, which can only be compensated with postoperative chemotherapy. Moreover, this patient did not undergo genetic screening, and it is currently unclear whether there are any genetic mutations associated with ureteric bud intestinal adenocarcinoma.

Medullary thyroid cancer (MTC) represents a small proportion of thyroid cancers. In MTC, melanin production is extremely uncommon. Few case reports have documented this rare variant, and follow-up on these cases has been very limited. Our case studies a 51-year-old female who initially presented with goiter. This tumor recurred multiple times despite surgery with rapid growth and poor response to radiotherapy. Microscopic examination showed high-grade malignant neoplasm with lymphocytic differentiation. Immunohistochemical studies were diffusely positive for S100, SOX10, and Melan-A. Histology confirmed melanocytic medullary carcinoma that had undergone a high-grade transformation with loss of epithelial and neuroendocrine expression. Due to the scarcity and rarity of this subtype, further evaluation and case studies are needed for further categorization and prognostication.

We report on an aggressive, infiltrating, metastatic, and ultimately lethal basaloid type of carcinoma arising shortly after an mRNA vaccination for COVID-19. The wife of the patient, since deceased, gave the consent for publishing the case. The malignancy was of cutaneous origin and the case showed symptoms consistent with Bell\'s palsy and trigeminal neuralgia beginning four days post-vaccination (right side head temporal pain). The temporal pain was suggestive for inflammation and impairment of T cell immune activation. Magnetic Resonance Imaging (MRI) showed a vascular loop on the left lateral aspect of the 5th cranial root exit of cerebellopontine angle constituting presumably a normal variant and was considered as an unrelated factor to the right-sided palsy and pain symptoms that corresponded to cranial nerves V (trigeminal nerve) and VII (facial nerve). In this study we describe all aspects of this case and discuss possible causal links between the rapid emergence of this metastatic cancer and mRNA vaccination. We place this within the context of multiple immune impairments potentially related to the mRNA injections that would be expected to potentiate more aggressive presentation and progression of cancer. The type of malignancy we describe suggests a population risk for occurrence of a large variety of relatively common basaloid phenotype cancer cells, which may have the potential for metastatic disease. This can be avoidable with early diagnosis and adequate treatment. Since facial paralysis/pain is one of the more common adverse neurological events following mRNA injection, careful inspection of cutaneous/soft tissue should be conducted to rule out malignancy. An extensive literature review is carried out, in order to elucidate the toxicity of mRNA vaccination that may have led to the death of this patient. Preventive and precise routine clinical investigations can potentially avoid future mortalities. See also Figure 1(Fig. 1).

BACKGROUND: Metastatic melanoma (MM) is an uncommon finding in serous effusion specimens with a highly variable cytomorphology.
METHODS: We reviewed specimens submitted over a 19-year period to determine (a) the range of cytologic findings in effusion specimens from melanoma patients and (b) the cytologic presentation and immunoprofile of MM in effusion specimens.
RESULTS: Of 123 serous effusion specimens from patients with clinical notes of melanoma, 59% were reported negative for malignancy, 16% were reported with a non-melanoma malignancy, 19% MM, and 6% atypical, MM not excluded. Pleural fluids were twice as likely to be reported as MM than peritoneal samples. Review of 44 cases with confirmed MM showed the most common cytologic pattern was epithelioid. Most (88%) cases contained mainly dispersed plasmacytoid cells, but many (61%) also contained malignant cells arranged in loose groups. Rare cases also had spindle cells, giant bizarre cells, small lymphoid-like cells, or cells with large hard-edged vacuoles, mimicking other metastatic malignancies. MM cases containing predominantly plasmacytoid cells often mimicked reactive mesothelial cells. As well as being composed of cells of similar size, features such as bi- and multinucleation, round nuclei, mild anisokaryosis, nucleoli, and loose groups were common to both. Features seen more commonly in MM than reactive cells included large nucleoli (95%) and intranuclear cytoplasmic inclusions (41%), binucleate \"bug-eyed demons,\" and small punctate vacuoles on the air-dried preparations. Pigment was identified in 36% of cases. Immunohistochemistry (IHC) is a valuable aid in confirming the cell type. The sensitivity for the most commonly used melanoma markers was as follows: S100 84% (21/25), pan-melanoma 100% (19/19), HMB45 92% (11/12), Melan A 92% (11/12), SOX10 91% (10/11). No staining was reported for calretinin (0/21), AE1/AE3 (0/11), EMA (0/16), Ber-Ep4 (0/13).
CONCLUSIONS: Effusion specimens from patients with a history of melanoma are frequently (40%) malignant but almost as likely to be reported as a nonmelanoma malignancy as MM. The cytology of MM may mimic a wide range of other metastatic malignancies but also often closely resembles reactive mesothelial cells. It is important to be aware of this latter pattern so that IHC markers can be applied.

Primary cutaneous anaplastic large cell lymphoma (PCALCL) is a subtype of non-Hodgkin lymphoma (NHL) that is localized to the skin. Disseminated disease is rare, and visceral organ involvement is even more so. We report a unique case of PCALCL with gastric metastasis. A 75-year-old man with a history of cutaneous left lower extremity PCALCL status post radiation therapy initially presented with abdominal pain and was found to have diffuse celiac axis and retroperitoneal lymphadenopathy. Endoscopy, initially done to biopsy an involved lymph node (LN), demonstrated a friable gastric nodular lesion with telangiectasias. Biopsy of the lesion and LN revealed anaplastic large cell lymphoma, identical in pathology to the known skin lesion. The patient was treated with systemic chemotherapy with a good response. PCALCL has been thought of as a localized malignancy with a good prognosis and low potential for extracutaneous spread. To our knowledge, this is the first instance of metastatic PCALCL involving the stomach.

BACKGROUND: Back pain is a rare initial presentation of gastric cancer. Isolated back pain with red flags in middle-aged patients might indicate multiple myeloma. However, it is rarely present in advanced gastric adenocarcinoma; hence, data are limited to case reports only. For a timely diagnosis of the underlying malignancy, endoscopy should be considered if the initial workup for this backache is unrevealing.
METHODS: We present a 34-year-old previously healthy gentleman with severe unremitting backache. He was ultimately diagnosed with gastric adenocarcinoma stage IV and received palliative treatment. The manuscript also reviewed relevant literature.
CONCLUSIONS: In rare cases, gastric malignancy can initially present as back pain with lytic bone lesions, mimicking multiple myeloma. Endoscopy early in the course of investigations may help reduce associated morbidities. Further, more extensive studies are required to understand better the clinical characteristics, demographics, and management of such patients.

Isolated facial nerve palsy resulting from temporal bone metastasis is rare and has been sparsely reported in the literature to be the initial presentation of cancer. The most commonly reported sites of origin of such metastases include the breast, lung, kidney, gastrointestinal tract, larynx, prostate, and thyroid, to name a few. Here, we discuss a patient initially presenting with isolated lower motor neuron facial nerve palsy. The diagnosis was revised to that of breast cancer with metastasis to the temporal bone resulting in facial nerve paralysis following the subsequent clinical presentation.

Immunoglobulin A (IgA) vasculitis is a rare disease in the older adult patient population. It is often triggered by an underlying etiology such as infection or malignancy. Paraneoplastic cases have been reported in the geriatric population in literature but the exact prevalence is unknown. Diagnosis requires satisfaction of both clinical and laboratory criteria, with additional emphasis on finding an underlying etiology. Treatment is focused on supportive care and may include immunosuppressive therapy. However, targeting the primary cause is also important for improving outcomes. Our patient in this report presented with a novel case of paraneoplastic IgA vasculitis that likely occurred secondary to lung adenocarcinoma.

BACKGROUND: Cystic angiomatosis is a rare benign disease presents with multiple lytic and sclerotic bone lesions mimicking a metastatic malignant neoplasia with less than 50 cases have been reported in literature so far.
METHODS: We reported a case of a 48-year-old woman who presented to an oncology clinic with multiple lytic and sclerotic bone lesions. Oncologic investigation for metastatic malignant neoplasia started. After that the negative results were obtained by evaluating the primary tumor site, a final diagnosis of cystic angiomatosis was made according to bone biopsy results.
CONCLUSIONS: Cystic angiomatosis is a rare disease with unpredictable prognosis. It can mimic metastatic malignancy especially when it presents at old age.