Chimeric Antigen Receptor (CAR) T cell therapy has recently begun to be used for solid tumors such as glioblastoma multiforme. Many children with pediatric malignant brain tumors develop extensive long-term morbidity of intensive multimodal curative treatment. Others with certain diagnoses and relapsed disease continue to have limited therapies and a dismal prognosis. Novel treatments such as CAR T cells could potentially improve outcomes and ameliorate the toxicity of current treatment. In this review, we discuss the potential of using CAR therapy for pediatric brain tumors. The emerging insights on the molecular subtypes and tumor microenvironment of these tumors provide avenues to devise strategies for CAR T cell therapy. Unique characteristics of these brain tumors, such as location and associated morbid treatment induced neuro-inflammation, are novel challenges not commonly encountered in adult brain tumors. Despite these considerations, CAR T cell therapy has the potential to be integrated into treatment schema for aggressive pediatric malignant brain tumors in the future.

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Lymphoma of the breast is a rare diagnosis, accounting for less than 0.5% of all breast malignancies. Presentation is usually similar to that of breast cancer, with a painless palpable mass. This report describes a unique case of a 13 cm breast lymphoma. The patient is a 74 year old female who presented to clinic with a right breast mass that has been present since the 1970s. She had previously undergone multiple excisions of lesions on both breasts, always with benign pathology. In 2017, screening mammogram revealed a suspicious lesion in the right upper outer breast with associated axillary lymphadenopathy. She was lost to follow up but presented again after the mass significantly grew in size over several months. Mammography showed a large 13 x 8.7 cm lobulated mass. Biopsy of the lesion revealed diffuse large B-cell lymphoma. Treatment for this patient will begin with chemotherapy.

Metastases from other primary malignancies to the breast are extremely rare, with an incidence of up to 2%. Renal cell carcinoma (RCC) is known to form micrometastases in unusual organs. This report describes a case of a RCC metastasis to the breast that was identified 20 years after nephrectomy. The patient, a 68-year-old female, presented after a new abnormality was found on a screening mammogram. The biopsy, which was reviewed by several pathologists, revealed a renal cell carcinoma metastasis. Imaging confirmed no other metastases, and she was treated with a partial mastectomy. This case highlights how RCC metastases can be found many years after a nephrectomy, and staining for RCC should be considered in patients with this history and a newly identified breast mass.

The histiocytoid variant of invasive lobular carcinoma (ILC) is a rare subtype of breast cancer that can be challenging to diagnose and aggressive in nature. It is often diagnosed after the disease has metastasized. This report describes a case of a six-centimeter ILC of the histiocytoid subtype. The patient is a 66-year-old female who was initially told that she had dense breast tissue. At the time of diagnosis, she had a large mass and was found to have metastases to the axillary lymph nodes and vertebra. She was started on chemotherapy and immunotherapy, but has since developed multiple new lesions to her spine, rib, and femur. This case highlights the aggressive nature of this variant, which progressed while during treatment.