Personalized and Precision Medicine Journal

Abstract We present a Non-Small Cell Lung Cancer Grade IV patient, diagnosed at 46 years of age, with multiple relapse from the diagnosis and demonstrating a poor prognosis after 3 cycles of treatments. A clinical comprehensive genomic profile was performed with the goal of finding potential actionable molecular alterations. The patient showed significant symptomatic and laboratory improvement with a combination chemotherapy determined by the molecular profiling, which would otherwise not have been considered. The mentioned approach was conducted since no other targeted therapies seemed actionable for him.

Abstract Background
Cancer associated thrombotic microangiopathy (CA-TMA) is a rare diagnosis that while confronting a patient with evidence of microangiopathic hemolytic anemia and thrombocytopenia with normal ADAMTS13 enzyme activity, should be considered. Here we present two cases of cancer associated TMA; breast cancer and gastric cancer.
Case presentation
Case 1 was a 40-year-old man presented with abdominal pain, icterus and weight loss and laboratory tests revealed microangiopathic hemolytic anemia. He received 6 sessions of plasma exchange under diagnosis of thrombotic thrombocytopenic purpura. Bone marrow biopsy and immunohistochemistry revealed clusters of non-hematopoietic cells suggestive of gastrointestinal adenocarcinoma. Case 2 was a 51-year-old woman whose clinical history and laboratory tests were similar to case 1 except for a breast mass along with axillary lymphadenopathy. Bone marrow examination revealed clusters of non-hematopoietic cells and core needle biopsy revealed invasive lobular carcinoma.
Both patients were unresponsive to plasma exchange and case 1 unfortunately shortly died after diagnosis but case 2 is alive and survived after receiving chemotherapy. 
Conclusion
Cancer associated TMA can rarely be seen as the first manifestation of a malignancy and causes a diagnostic dilemma for clinicians.The prognosis of CA-TMA is generally poor and initiatingchemotherapy is the only reliable treatment option.

Abstract The synovial joints are most affected by the systemic autoimmune inflammatory condition known as rheumatoid arthritis (RA). A unique and underappreciated link exists between rheumatoid vasculitis (RV), an extra-articular symptom of RA, and Inflammatory Aortic Disease (aortitis). In this article, we describe the case of a 64-year-old lady who had RA-associated aortitis and conducted a literature search on the condition. Patients with RA-associated aortitis received an average oral steroid dosage of 40.2 mg/day of prednisolone (PSL). Due to the patient's RV-related symptoms, including epidermal ulceration, a significant rheumatoid factor titer, and a modest PSL dosage significantly alleviated the clinical features, it was assumed that RV also caused our patient's aortitis. Early identification and the start of therapy are crucial since RA-associated aortitis may be lethal if left untreated.