Neil Gupta, MD

A 70-year-old man with history of hypertension, diabetes and chronic kidney disease was diagnosed with an early stage right papillary thyroid carcinoma in 1999.

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 60-year-old man presented with right thigh pain for the past 3 months. He also noted a mass progressively growing at his right thigh around this time. He did not seek medical advice until now.

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 54-year-old woman was initially diagnosed with left breast cancer 11 years ago. Based on left lumpectomy, axillary lymph node dissection and imaging she was staged as cT2N1M0. Her tumor was ER/PR negative and HER2-neu low. She received adjuvant chemotherapy with doxorubicin and cyclophosphamide followed by paclitaxel. She received radiation to left breast, supraclavicular and intramammary lymph nodes.

A 71-year-old woman presented to her physician after several months with enlarged cervical lymph nodes. A biopsy was done, confirming classical Hodgkin’s lymphoma. A staging FDG-PET/CT revealed extensive hypermetabolic cervical, axillary, mediastinal, left hilar, and abdominal lymphadenopathy and prominent activity throughout the bone marrow. However, a biopsy of the bone marrow was negative, and she was diagnosed with stage III Hodgkin’s lymphoma. Metabolic activity in the spleen was higher than that in the liver, raising the possibility of diffuse splenic infiltration with lymphoma. The patient underwent four cycles of standard chemotherapy with ABVD, and restaging FDG-PET/CT revealed decreased metabolic activity in the spleen relative to the liver, suggestive of positive response to therapy. It also revealed positive functional and anatomic response to therapy of all involved lymph node regions. Follow-up FDG-PET/CT two months after completion of chemotherapy confirmed this finding and FDG activity in the liver remained higher than in the spleen, consistent with ongoing response to treatment.

A 40-year-old woman presented to our hospital with a painless right axillary mass with duration of two months. Her history included stage IIA right breast cancer diagnosed 18 months prior. She underwent mastectomy and sentinel lymph node sampling followed by immediate transverse rectus abdominis muscle reconstruction. The tumor was a multifocal, moderately differentiated infiltrating lobular carcinoma with extensive ductal carcinoma in situ, and nonsentinel lymph node from the right axillary tail of the breast was positive for macrometastasis. The tumor was ER-positive, PR-positive and HER-2/neu-negative. She received adjuvant chemotherapy with four cycles of dose dense doxorubicin and cyclophosphamide and is currently on adjuvant hormonal therapy with tamoxifen.