Metaplastic carcinoma of the breast (MCB) is a rare form of cancer containing mixture of epithelial and mesenchymal elements in variable combinations. Few and conflicting clinical data are available in the literature addressing optimal treatment modalities, prognosis and outcome. A retrospective study was conducted to review all patients with MCB diagnosed and treated at King Faisal Specialist Hospital and Research Center between 1994-2004. The aim is to describe patient's clinicopathologic features and to analyze treatment results. Nineteen female patients were studied. The median age was 48 years (range, 14-58). The median tumor size was 9 cm (range, 3-18). Stage distribution was II in 8 patients, III in 9 and IV in 2. Nine cases were identified as purely epithelial and 10 (53%) as mixed epithelial and mesenchymal metaplasia. Hormone receptors were positive in only 2 patients. Modified radical mastectomy performed in 11 patients and 15 underwent axillary node dissection. Adjuvant chemotherapy was given to 9 patients and postoperative radiotherapy to 8. Twelve patients relapsed with median time of relapse of 12 months (range, 2-28). At a median follow-up of 21 months (range, 7-83), the 3-year event free survival (EFS) and overall survival for the patients diagnosed with loco-regional disease were 15% and 48% respectively. Tumor size correlated significantly with EFS. MCB is an aggressive form of breast cancer associated with poor outcome, high incidence of local recurrence and pulmonary metastases. The disease tends to be estrogen/progesterone receptor negative. Tumor size has an important impact on outcome. The best treatment approach is yet to be defined.

The authors treated 14 patients with advanced squamous cell carcinoma (SCC) of the skin or lip with one to four cycles of combination chemotherapy consisting of cisplatin by bolus injection, and 5-fluorouracil (5-FU) and bleomycin by continuous 5-day infusion. Objective responses were seen in 11 of the 13 evaluable patients (84%). Four patients had a complete remission (30%) and seven patients, a partial remission (54%). Local control after definitive complementary radiation and/or surgical treatment was achieved in seven patients. Toxic side effects was acceptable; they consisted of nausea and vomiting in all patients, transient skin changes, hematologic (Grade 3/4) abnormalities in four patients, and pulmonary fibrosis in one elderly patient. These results show that this chemotherapy combination could play a role in reducing the tumor mass and in facilitating definitive treatment to obtain better functional and cosmetic results in advanced SCC of the skin.

From 1996 to April 2006, 174 consecutive patients with relapsed or refractory diffuse large cell lymphoma (DLCL) and Hodgkin lymphoma (HL) received ESHAP as salvage and for mobilisation. Males 92, females 76. DLCL 64: HL 104, prior radiation in 35%. First relapse 45%, second relapse 12%, induction failure 43%. Median prior chemotherapy cycles were 6. Median age at apheresis was 26.5 years. Six patients failed mobilisation and 21 patients had CD34+ cells collection < 2 x 10(6)/kg on first apheresis. Median CD34+ cells/kg collection was 5.5 x 10(6)/kg for first apheresis and 6.7 x 10(6)/kg for all apheresis. We evaluated impact of histology, gender, age, stage, marrow involvement, prior radiation and chemotherapy cycles, timing (relapse1: relapse > 1: refractory), platelet count and weight. For first apheresis collection; all patients, younger age (p = 0.004), for DLCL (64), younger age (p = 0.021) and higher platelet count (p = 0.013) and for HL (104), younger age (p = 0.036) and male gender had better CD34+ cells collection. For all apheresis product, for all patients, age (p = 0.001) and no prior radiation therapy (p = 0.051) had better CD34+ cells collection. Higher first harvest CD34+ cells collection also resulted in early neutrophil (p < or = 0.001) and platelet (p = 0.004) engraftment.

Highlights d Human PSC-derived pancreas and intestinal endocrine cells to model NEUROG3 mutations d NEUROG3 mutations affect protein stability, dimerization, and DNA binding d NEUROG3 protein is less stable in intestinal epithelium than in the pancreas d Reduced protein stability in intestine enhances sensitivity to NEUROG3 mutations

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