Liana Makarian, MD

The patient is a 47-year-old man with fairly well-controlled HIV/AIDS, hepatitis B without cirrhosis and former polysubstance user, with pulmonary dysfunction secondary to idiopathic fibrosis. He was diagnosed with stage IV Hodgkin’s disease involving the liver and bone marrow. His baseline diffusion capacity for carbon monoxide was decreased, precluding therapy with bleomycin. As such, he received CEPP regimen that consisted of cyclophosphamide 600 mg/m2 IV on day 1 and 8; etoposide 70 mg/m2 IV on days 1 to 3; procarbazine (Matulane, Sigma Tau) 60 mg/m2 orally on days 1 to 10; and prednisone 60 mg/m2 orally on days 1 to 10.

A 67-year-old woman with an extensive history of smoking initially presented complaining of a persistent cough. An evaluation with chest CT showed a 6.7-cm left upper lobe cavitary lesion extending to the hilum with enlarged bilateral mediastinal adenopathy.

An 80-year-old woman with personal history of early-stage breast cancer, treated with lumpectomy and radiation 11 years ago, initially presented with lower gastrointestinal bleeding in June 2008. Her colonoscopy revealed a fungating, infiltrative and ulcerated partially obstructing large 7 cm mass in sigmoid colon.

A 36-year-old woman originally presented in January 2007 with a palpable mass. She underwent bilateral mammogram and left breast ultrasound that revealed a 1.6 cm mass and a 0.8 cm left axillary lymph node. A subsequent ultrasound guided core biopsy of the left breast mass and an aspiration of the left axillary lymph node revealed invasive ductal carcinoma with the metastatic involvement of the left axillary lymph node.

The 70-year-old patient had initially presented with rectal bleeding. Colonoscopy revealed a large ulcerated, fungating, friable mass at 30 cm in the sigmoid colon. Biopsy showed an invasive adenocarcinoma. The imaging studies were negative for metastatic disease. Therefore, the patient subsequently underwent a sigmoid colon resection.