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Cutaneous squamous cell carcinoma has presented an increasing burden globally, with the occurrence of metastatic cutaneous squamous cell carcinoma being a relatively rare event but presenting with significant challenges in management, and a paucity of treatment options. Waldenström’s macroglobulinemia is similarly an infrequent diagnosis. We present a rare case of a synchronous diagnosis of cutaneous squamous cell carcinoma and Waldenström’s macroglobulinemia with an associated lung mass with squamous differentiation. The considered origin of the lung mass was either metastatic cutaneous squamous cell carcinoma or a primary squamous cell carcinoma of the lung, representing a third primary malignancy. The report highlights complexities in diagnosis and management, particularly in a patient with multiple synchronous malignancies. It further emphasizes the need for expanded global availability of specific therapies, including PD-1 inhibitors.

Testicular metastases are a rare finding. Typically, a testicular metastasis will present as a complication of progressive disease or as a primary sign of malignancy. Excluding lymphoma and leukemia, prostate cancer is the most common primary site that metastasizes to the testes. Testicular metastases resulting from squamous cell carcinoma of the lung have rarely been reported in previous literature. Here, we report a case of stage IV squamous cell carcinoma of the lung with metastases to the brain and multiple bilateral lung lesions. Following palliative systemic chemotherapy, this patient was found to have a right testicular mass. Pathology reports confirmed that this was a testicular metastasis of squamous cell lung carcinoma origin.

Nivolumab, a programmed death 1 (PD1) inhibitor, belongs to a family of drugs known as immune checkpoint inhibitors that share a similar toxicity profile, which includes rash, pruritus, colitis, hepatitis, pneumonitis and thyroid dysfunction. Nivolumab has a proven efficacy in the treatment of malignant melanoma, non-small cell lung cancer and renal cell carcinoma. We present the case of a 67-year-old male patient with metastatic squamous cell carcinoma of the lung who suffered from a massive pericardial effusion secondary to treatment with nivolumab, which he began in June 2015. After five cycles the patient was hospitalized due to acute respiratory failure requiring mechanical ventilation. An echocardiogram revealed a massive pericardial effusion with tamponade. After pericardiocentesis and corticosteroid treatment, the patient's condition improved rapidly. A CT scan revealed a response of the tumor. Although anti-PD1 treatment is usually regarded as less toxic than chemotherapy, a wide spectrum of life-threatening immune-related side effects may still occur and clinical vigilance is required.

We report the case of a 64-year-old ex-smoker with metastatic poorly differentiated squamous cell carcinoma (SCC) of the lung and an epidermal growth factor receptor (EGFR) mutation in exon 21 (p.L858R) who achieved prolonged clinical benefit from treatment with an EGFR tyrosine kinase inhibitor (TKI). The initial diagnosis of SCC of the lung obtained by bronchoscopic biopsy was based on immunohistochemical staining only with positivity for cytokeratin (CK) 5/6 and p63 because morphological diagnosis was not possible. Patients with non-small cell lung cancer (NSCLC), not otherwise specified (NOS) favouring SCC are usually not tested for the presence of EGFR mutations, and therefore may not receive EGFR TKI therapy. A bronchoscopic rebiopsy showed small nests of undifferentiated tumour cells with weak immunoreactivity of some tumour cells for CK5/6, p63 and no positivity of some tumour cells for thyroid transcription factor-1. These findings suggested a mixed squamous/glandular immunophenotype that has been missed at the initial biopsy. Our clinical case illustrates the problem of tumour heterogeneity encountered in small bronchoscopic biopsies and the difficulties of evaluating the histological subtype in poorly differentiated carcinomas. Initial bronchoscopy should be performed by an experienced pulmonologist who attempts to obtain sufficient material from different areas of the tumour. In the era of targeted therapy, a remote smoking history in a patient with NOS favouring SCC should also lead to EGFR mutation testing to allow highly effective therapy to be offered to mutation-positive patients.

An 85-year-old male with advanced squamous cell carcinoma of the lung, who was diagnosed about 10 years prior to his current presentation, suddenly complained of abdominal pain and underwent an abdominal computed tomography scan, which revealed free air and massive ascites. He was admitted to our hospital for acute peritonitis and emergency surgery was performed. During the surgical procedure, a perforation of the jejunum was diagnosed and repaired. He was diagnosed to have a metastatic tumor originating from a squamous cell carcinoma of the lung. He improved and was transferred to the former hospital on the 27th postoperative day. Jejunal metastasis from squamous cell carcinoma of the lung is rare, and the prognosis of peritonitis due to a perforated intestinal metastasis from lung cancer is poor. There have been 10 reports of jejunal metastasis of squamous cell carcinoma of the lung reported in Japan between 2000 and 2011. Therefore, when patients with advanced lung cancer present with acute abdomen, it is necessary to keep in mind the possibility of a gastrointestinal metastatic tumor., Case Reports in Gastroenterology, 5(3), pp.636-641; 2011

Primary penile carcinoma is one of the rarest male genital tract tumors. We rarely encounter this malignancy in Turkey because circumcision is routinely performed as a part of the Islamic tradition. Despite the medical paradox that the penis is rarely affected by metastases, approximately 300 cases have been reported in the literature. The primary lesion is almost 75% of pelvic origin; genitourinary or rectosigmoid primaries and penile metastasis from extrapelvic primaries constitute 25% of other primaries. Furthermore, isolated metastatic penile carcinomas are exceptionally rare. The rarity of the event prompted this study, which describes 10 cases of metastatic tumors of the penis including 7 cases with transitional cell carcinoma of the bladder, and in 1 case each of squamous cell carcinoma of the lung, adenocarcinoma of the prostate and leukemia. The main characteristics of the primary tumor are described, along with the diagnosis, treatment and the outcome of patients.

Background Wegener's granulomatosis (WG) is characterized by systemic, necrotizing, granulomatous inflammation accompanied by vasculitis. It classically involves the triad of the upper respiratory tract, lungs and kidneys. Isolated pulmonary lesions of WG may present in some patients as pulmonary masses, simulating neoplasms. The features of WG can be suggested by cytologic study. Atypical epithelial cells associated with WG have previously been reported as a cause of a false positive diagnosis of bronchoalveolar carcinoma. Case In this case the cytologic findings included atypical squamous cells in a background of acute, chronic and granulomatous inflammation. In several respiratory specimens the atypical squamous cells were incorrectly interpreted as diagnostic of squamous cell carcinoma. The correct diagnosis of WG was confirmed with open lung biopsy, which demonstrated necrotizing granulomatous inflammation with geographic necrosis and associated vasculitis. Conclusion Markedly atypical squamous cells mimicking squamous cell carcinoma can be found accompanying the inflammatory process associated with WG and are a possible diagnostic pitfall. The possibility of WG as well as other inflammatory processes should always be considered in the differential diagnosis of squamous cell carcinoma of the lung. This case is the only reported case of WG in which atypical squamous cells were a diagnostic pitfall, initially suggesting a diagnosis of squamous cell carcinoma.

Retinoids and interferon-alpha (IFN-alpha) have been shown to have a synergetic antiproliferative and differentiative effect on many cell lines, and in combination they have already been tested with some success in the treatment of some tumors. We investigated the tolerance and efficacy of high dose 13-cis-retinoic acid (2 mg/kg/day) and IFN-alpha in the treatment of advanced squamous cell carcinoma of the lung and of the head and neck. No partial or complete response was observed in the 10 patients treated. The toxicity was unusual and mild to moderate considering the dose of retinoid given. This observation leads us to suspect that IFN-alpha may alleviate some of the side effects of the retinoid, and is of interest in the design of future clinical trials.

of respiratory symptoms. All antineoplas-tic drugs were discontinued. With predni-sone 50 mg daily, tapered off over 6 weeks, symptoms resolved promptly, and lung function tests and CT scan after 6 weeks documented improvement ( table 1 ). We assumed bevacizumab more likely caus-ative for drug-induced pneumonitis than PLD as there are much more safety data available for PLD without clear evidence of interstitial pneumonitis related to PLD [1] . Thus, we decided to reinitiate PLD alone after a 3-month treatment holiday. No pul-monary side effects were noted, suggesting bevacizumab being the cause of interstitial pneumonitis. Pulmonary complications observed so far with bevacizumab are hemorrhage and hemoptysis, mainly ob-served in lung cancer patients and more commonly seen in patients with squamous cell carcinoma of the lung than in those with nonsquamous histology [2] . Only lately, a first description of interstitial pneumonitis in a patient treated with the [3] .drug-induced lung injury is poorly under-stood. Direct injury to pneumocytes or the alveolar capillary endothelium (chemical We report on a patient with metastatic breast cancer in whom interstitial pneu-monitis developed after treatment with bevacizumab in combination with pe-gylated liposomal doxorubicin (PLD). Re-exposure to PLD after recovery was with-out any pulmonary side effects. A 53-year-old woman presented with symptomatic histologically proven diffuse metastatic infiltration of the stomach as the only site of disease 5 years after pri-mary diagnosis of lobular breast cancer. Treatment with PLD (Caelyx ) 20 mg/m

We describe a 71-year-old man who presented with a bleeding duodenal ulcer 4 years after undergoing left pneumonectomy for primary squamous cell carcinoma. As the ulcer did not heal and continued to b

Intraarterial infusionstherapy was performed with cytostatic agents (10 patients) and proteolytic enzymes (4 patients) in 14 selected cases with malignant lung tumours. Diagnosis was in 8 patients small cell carcinoma, in 3 patients adenocarcinoma, in 2 patients squamous cell carcinoma of the lung and in 1 patient leiomyosarcoma of the lung (relapse). Infusions were performed in 8 cases through the A. bronchialis, in 5 through the A. pulmonalis and in 1 patient through the A. thoracica interna. After single infusions of cytostatic agents via the A. bronchialis, remissions of varying extents, were found in 5 out of 8 patients. Repeated infusions with enzymes (1-5 series) through the A. pulmonalis lead in 2 out of 4 cases to slight remissions with a duration of 5 and 12 months, respectively. Possibilities and limiting factors of this therapeutic modality are demonstrated by recent observations.

In 16 patients with cervical carcinoma (stages II and III) tumor-specific and general immune reactivity was investigated. Cancer patients' skin reactivity was different from that of controls insofar as there was a decreased response to streptokinase-streptodornase as well as to DNCB. Absence of DNCB sensitization was mainly in stage III patients. Cell-mediated immunity to autologous and/or allogeneic tumor-associated antigens (TAA) was demonstrated in vivo and in vitro. 3 of 8 patients had positive skin reactions to autologous TAA and 8 of 14 reacted to allogeneic TAA. In the lymphocyte migration inhibition test, 8 of 14 patients reacted to autologous tumor membrane preparations and 3 of 10 to allogeneic pooled preparations. In addition, there was some indication of cross-reaction with antigens from a human squamous cell carcinoma of the lung. There was no reaction in vitro to normal cervical tissue and no association between tumor-specific reactions and herpes simplex virus type II antibodies could be demonstrated. Patients with DNCB sensitization and in vivo as well as in vitro lymphocyte reactivity to TAA had a better prognosis than nonreacting patients, indicating the value of combined immunological tests.

Based on a clinical trial, in which patients with unresectable bronchogenic cancer were treated with a combination of vitamin A plus chemotherapy, or vitamin A plus radiotherapy, a study was initiated in which vitamin A alone was given for tumor treatment. 9 male patients with metastatic unresectable squamous cell carcinoma of the lung were treated with vitamin A palmitate or 13-cis vitamin A acid. Up to seven treatment courses were given during a period of 60 weeks. Through weekly evaluation of the patients' immune status, an immune potentiating effect of the vitamin A therapy could be demonstrated. An increase of lymphocyte blastogenesis response to PHA which is significant (p less than 0.001) compared with the pretreatment values, was found in all patients at the end of one vitamin A treatment course. Increased delayed cutaneous hypersensitivity reactions were observed also in all patients. The immune potentiating effects of vitamin A therapy, as well as the demonstrated direct effect on the tumor, introduces a wide range of combination therapies.

Using 3H-TdR pulse labelling, the cell kinetics of four, serially transplantable, human tumors were studied in athymic nude mice. Squamous cell carcinoma of the lung, tongue and esophagus showed relatively similar cell kinetic parameters. The growth of an oat-cell carcinoma was initially very slow in mice and its growth fraction was unexpectedly small with a relatively low labelling index. Its postmitotic phase was very short. It was concluded that the nude mice/human tumor system may be useful for cell kinetic studies of human tumors from the standpoint of tumor biology and therapy.

Based on a clinical trial, in which patients with unresectable bronchogenic cancer were treated with a combination of vitamin A plus chemotherapy, or vitamin A plus radiotherapy, a study was initiated in which vitamin A alone was given for tumor treatment. 9 male patients with metastatic unresectable squamous cell carcinoma of the lung were treated with vitamin A palmitate or 13-cis vitamin A acid. Up to seven treatment courses were given during a period of 60 weeks. Through weekly evaluation of the patients' immune status, an immune potentiating effect of the vitamin A therapy could be demonstrated. An increase of lymphocyte blastogenesis response to PHA which is significant (p less than 0.001) compared with the pretreatment values, was found in all patients at the end of one vitamin A treatment course. Increased delayed cutaneous hypersensitivity reactions were observed also in all patients. The immune potentiating effects of vitamin A therapy, as well as the demonstrated direct effect on the tumor, introduces a wide range of combination therapies.

A male patient, operated for squamous cell carcinoma of the lung, in whom sarcoidosis was discovered in the resected lung specimen, is reported. The increased association of sarcoidosis along with malignant diseases is discussed, as well as the various mechanisms probably responsible for this association.