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Dar N, Wills A, Berg S, Gradecki SE, Cropley TG, Guffey D. Cutaneous mucormycosis with suspected dissemination in a patient with metastatic adrenocortical carcinoma. Med Mycol Case Rep 2024; 44:100646. [PMID: 38623179 PMCID: PMC11017034 DOI: 10.1016/j.mmcr.2024.100646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 03/23/2024] [Accepted: 04/01/2024] [Indexed: 04/17/2024] Open
Abstract
Mucormycosis is a frequently lethal fungal infection that most commonly affects patients with poorly controlled diabetes or other immunosuppressed states. We report the case of a suspected disseminated Rhizopus infection in a patient who was pursuing naturopathic treatment including mud baths for metastatic adrenocortical carcinoma. He was empirically treated with liposomal amphotericin B but opted to stop treatment following multiorgan failure. The patient passed away on the tenth day of his hospital admission.
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Affiliation(s)
- Nakul Dar
- School of Medicine, University of Virginia, Charlottesville, VA, 22908, USA
| | - Abigail Wills
- Department of Dermatology, University of Virginia, Charlottesville, VA, 22908, USA
| | - Scott Berg
- Department of Dermatology, University of Virginia, Charlottesville, VA, 22908, USA
| | - Sarah E. Gradecki
- Department of Pathology, University of Virginia, Charlottesville, VA, 22908, USA
| | - Thomas G. Cropley
- Department of Dermatology, University of Virginia, Charlottesville, VA, 22908, USA
| | - Darren Guffey
- Department of Dermatology, University of Virginia, Charlottesville, VA, 22908, USA
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Vargas PA, Dar N, de Souza Martins Fernandes E, Goldaracena N. Surgical approach to achieve R0 resections in primary and metastatic liver tumors: a literature review. J Gastrointest Oncol 2023; 14:1949-1963. [PMID: 37720424 PMCID: PMC10502561 DOI: 10.21037/jgo-22-778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 12/15/2022] [Indexed: 09/19/2023] Open
Abstract
Background and Objective Primary and metastatic liver tumors are a significant cause of mortality worldwide. Regardless of the etiology of the tumor, macro- and microscopically clear margins (R0) while preserving adequate function of the remaining organ are the main goals after liver resections. However, technically challenging procedures are required to achieve R0 resection. Currently, there is no consensus of which should be the ideal minimal safety margin for liver tumor resections, with contrasting reports in regards of safety, tumor recurrence and overall outcomes following R0. Therefore, we aim to review current worldwide surgical practices to achieve R0 resections for primary and metastatic liver tumors in challenging surgical techniques and their reported outcomes. Methods PubMed database, Google Scholar, and OVID Medline were searched for peer-reviewed original articles related to surgical techniques performed to achieve R0 resections in the setting of primary and/or metastatic liver tumors. An up-to-date review of English-language articles published between 2015 to July 2022 was performed. Key Content and Findings Primary and metastatic liver tumors can be effectively treated using hepatic resection. Current literature highlights that tumors involving major vascular structures are not uncommon. Surgical advances have allowed for vascular control techniques, as well as vascular resections to be performed in a feasible and safe manner to achieve R0 resections. Complex resections combining surgical techniques can be performed in certain population after a detailed evaluation. Liver transplantation (LT) have been used with varying degrees of success for treatment of patients with hepatocellular carcinoma, cholangiocarcinoma (CCA), colorectal liver metastases (CRLM), non-resectable CRLM and metastatic neuroendocrine tumors. Conclusions Safety and feasibility of R0 resections have been reported for multiple techniques. Technical complexity should not be a limitation to achieve or pursue R0 tumor resection. However, there has to be a balance between patient risk/benefit in attempting R0 resections. Adequate training of surgeons on implementation of complex techniques, as well as transplant oncology techniques applied to hepato-pancreato-biliary (HPB) surgery represents as a promising path to improve short and long-term outcomes for liver-related oncology patients.
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Affiliation(s)
- Paola A. Vargas
- Division of Transplant Surgery, Department of Surgery, University of Virginia Health System, Charlottesville, VA, USA
| | - Nakul Dar
- School of Medicine, University of Virginia Health System, Charlottesville, VA, USA
| | | | - Nicolas Goldaracena
- Division of Transplant Surgery, Department of Surgery, University of Virginia Health System, Charlottesville, VA, USA
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Dar N, Gradecki SE, Gaughan EM. Case Report: Dynamic overlap of melanoma, sarcoidosis, and targeted therapy for BRAF-mutant melanoma. Front Oncol 2023; 13:1217179. [PMID: 37706179 PMCID: PMC10495986 DOI: 10.3389/fonc.2023.1217179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 07/31/2023] [Indexed: 09/15/2023] Open
Abstract
Targeted therapies, including BRAF and MEK inhibitors, are valuable treatment options for patients with unresectable or metastatic BRAF V600-mutant melanoma. With the improvement in survival seen with modern melanoma therapeutics, clinicians are learning the variable patterns associated with extended clinical courses. Sarcoidosis is characterized by non-caseating granulomatous inflammation of unknown etiology, often presenting with cutaneous, lung, or lymph node involvement. There is a known association between sarcoidosis and melanoma, and sarcoidosis is increasingly seen and described in the setting of anti-melanoma therapy. The challenge for clinicians is to differentiate between sarcoid-related and malignancy-related findings, which may follow a variable course over years. We present two cases of BRAF and MEK inhibitor-related sarcoidosis in patients with melanoma and review the literature. The dynamic nature of the clinical and radiographic findings impacted patient management and clinical decisions for years of their treatment course.
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Affiliation(s)
- Nakul Dar
- University of Virginia School of Medicine, Charlottesville, VA, United States
| | - Sarah E. Gradecki
- Department of Pathology, University of Virginia, Charlottesville, VA, United States
| | - Elizabeth M. Gaughan
- Division of Hematology and Medical Oncology, Department of Medicine, University of Virginia, Charlottesville, VA, United States
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Dar N, Mantziaris G, Pikis S, Young L, Sheehan J. Stereotactic radiosurgery for intracranial primary melanocytomas. World Neurosurg 2022; 164:160-166. [PMID: 35552031 DOI: 10.1016/j.wneu.2022.04.136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 04/26/2022] [Accepted: 04/27/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE The role of stereotactic radiosurgery (SRS) in the management of recurrent and residual intracranial primary melanocytomas (PMC) remains unclear. The aim of this study is to evaluate the safety and efficacy of SRS in the management of these rare tumors. METHODS One patient treated with SRS in our institution for an intracranial PMC was retrospectively identified. Additionally, a systematic review of English articles using MEDLINE was performed to identify studies reporting on treatment and tumor characteristics and patient outcomes following SRS-management of intracranial PMC. RESULTS Including our institution's patient, a total of 13 patients (11 males and 2 females) met the inclusion criteria and were analyzed. The median age at SRS treatment was 49 years [Interquartile range (IQR) 27]. At a median follow-up of 24 (IQR 48) months, the aggregate local tumor-control rate was 76.9%. Progression occurred in three patients and was managed with repeat SRS (1/13) or salvage resection (2/13). One case of malignant transformation to melanoma leading to leptomeningeal dissemination and death was noted. CONCLUSION SRS appears to be a reasonable treatment option for recurrent and residual melanocytomas. A higher prescription dose might be reasonable in the treatment of intermediate grade or recurring PMC. Close longitudinal follow up for recurrence or malignant transformation of melanocytomas after SRS is recommended.
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Affiliation(s)
- Nakul Dar
- Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - Georgios Mantziaris
- Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - Stylianos Pikis
- Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - Lena Young
- Department of Neuropathology, University of Virginia, Charlottesville, Virginia, USA
| | - Jason Sheehan
- Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia, USA.
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Jones MR, Schrader KA, Shen Y, Pleasance E, Ch'ng C, Dar N, Yip S, Renouf DJ, Schein JE, Mungall AJ, Zhao Y, Moore R, Ma Y, Sheffield BS, Ng T, Jones SJM, Marra MA, Laskin J, Lim HJ. Response to angiotensin blockade with irbesartan in a patient with metastatic colorectal cancer. Ann Oncol 2016; 27:801-6. [PMID: 27022066 PMCID: PMC4843189 DOI: 10.1093/annonc/mdw060] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Accepted: 02/08/2016] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND A patient suffering from metastatic colorectal cancer, treatment-related toxicity and resistance to standard chemotherapy and radiation was assessed as part of a personalized oncogenomics initiative to derive potential alternative therapeutic strategies. PATIENTS AND METHODS Whole-genome and transcriptome sequencing was used to interrogate a metastatic tumor refractory to standard treatments of a patient with mismatch repair-deficient metastatic colorectal cancer. RESULTS Integrative genomic analysis indicated overexpression of the AP-1 transcriptional complex suggesting experimental therapeutic rationales, including blockade of the renin-angiotensin system. This led to the repurposing of the angiotensin II receptor antagonist, irbesartan, as an anticancer therapy, resulting in the patient experiencing a dramatic and durable response. CONCLUSIONS This case highlights the utility of comprehensive integrative genomic profiling and bioinformatics analysis to provide hypothetical rationales for personalized treatment options.
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Affiliation(s)
- M R Jones
- British Columbia Cancer Agency, Canada's Michael Smith Genome Sciences Centre, Vancouver
| | - K A Schrader
- Department of Medical Genetics, University of British Columbia, Vancouver
| | - Y Shen
- British Columbia Cancer Agency, Canada's Michael Smith Genome Sciences Centre, Vancouver
| | - E Pleasance
- British Columbia Cancer Agency, Canada's Michael Smith Genome Sciences Centre, Vancouver
| | - C Ch'ng
- British Columbia Cancer Agency, Canada's Michael Smith Genome Sciences Centre, Vancouver
| | - N Dar
- British Columbia Cancer Agency, Canada's Michael Smith Genome Sciences Centre, Vancouver
| | - S Yip
- Department of Pathology and Laboratory Medicine, Vancouver General Hospital, Vancouver
| | - D J Renouf
- Division of Medical Oncology, British Columbia Cancer Agency, Vancouver
| | - J E Schein
- British Columbia Cancer Agency, Canada's Michael Smith Genome Sciences Centre, Vancouver
| | - A J Mungall
- British Columbia Cancer Agency, Canada's Michael Smith Genome Sciences Centre, Vancouver
| | - Y Zhao
- British Columbia Cancer Agency, Canada's Michael Smith Genome Sciences Centre, Vancouver
| | - R Moore
- British Columbia Cancer Agency, Canada's Michael Smith Genome Sciences Centre, Vancouver
| | - Y Ma
- British Columbia Cancer Agency, Canada's Michael Smith Genome Sciences Centre, Vancouver
| | - B S Sheffield
- Department of Pathology and Laboratory Medicine, Vancouver General Hospital, Vancouver
| | - T Ng
- Department of Pathology and Laboratory Medicine, Vancouver General Hospital, Vancouver
| | - S J M Jones
- British Columbia Cancer Agency, Canada's Michael Smith Genome Sciences Centre, Vancouver Department of Medical Genetics, University of British Columbia, Vancouver Department of Molecular Biology and Biochemistry, Simon Fraser University, Vancouver, Canada
| | - M A Marra
- British Columbia Cancer Agency, Canada's Michael Smith Genome Sciences Centre, Vancouver Department of Medical Genetics, University of British Columbia, Vancouver
| | - J Laskin
- Division of Medical Oncology, British Columbia Cancer Agency, Vancouver
| | - H J Lim
- Division of Medical Oncology, British Columbia Cancer Agency, Vancouver
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Pervaiz S, Shaheen T, Shaheen S, Dar N, Samra Z. Purification, characterization and preparation immunomatrixes of S-layer proteins of Thermobifida fusca. J Appl Microbiol 2013; 115:735-43. [DOI: 10.1111/jam.12259] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2013] [Revised: 05/14/2013] [Accepted: 05/18/2013] [Indexed: 11/27/2022]
Affiliation(s)
- S. Pervaiz
- Institute of Biochemistry and Biotechnology; University of the Punjab; Lahore Pakistan
| | - T. Shaheen
- Institute of Biochemistry and Biotechnology; University of the Punjab; Lahore Pakistan
| | - S. Shaheen
- Institute of Biochemistry and Biotechnology; University of the Punjab; Lahore Pakistan
| | - N. Dar
- Department of Biology; Jinnah Degree College for Women; Lahore Pakistan
| | - Z.Q. Samra
- Institute of Biochemistry and Biotechnology; University of the Punjab; Lahore Pakistan
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Dar N, Shakoori AR. Chromium tolerant yeast strains isolated from industrial effluents and their possible use in environmental clean-up. Bull Environ Contam Toxicol 1999; 63:744-750. [PMID: 10594148 DOI: 10.1007/s001289901042] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Affiliation(s)
- N Dar
- Cell and Molecular Biology Laboratory, Department of Zoology, University of the Punjab, New Campus, Lahore 54590 Pakistan
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