Comparison of Serum Fibrin-Fibrinogen Degradation Products with Carcinoembryonic Antigen as Biomarkers for Colon Cancer / 임상검사와정도관리

BACKGROUND: Colon cancer is the second most common cancer in males and fourth most common in females in Korea. The levels of serum fibrin-fibrinogen degradation products (FDP) are elevated in many malignancies due to haemostatic alterations resulting from carcinogenesis. We compared serum FDP with carcinoembryonic antigen (CEA) to assess whether FDP has a diagnostic value for colon cancer. METHODS: A total of 177 serum samples from 95 colon cancer patients and 82 healthy controls were provided by the Korea Cancer Center Hospital biobank. Serum FDP levels were measured using the DR-70 detection kits (AMDL, USA) and the levels of serum CEA were measured using the Roche E170 Analytics (Roche Diagnostics, Germany). RESULTS: The mean serum FDP and serum CEA levels were significantly higher in the cancer patient group (FDP, 1.65+/-1.44 microg/mL; range, 0.36 to 9.48; CEA, 99.99+/-321.74 ng/mL; range, 1.46 to 2,170.00) than in the control group (FDP, 0.58+/-0.46 microg/mL; range, 0.02 to 3.27, P<0.05; CEA, 1.66+/-1.18 ng/mL; range, 0.20 to 6.38, P<0.05). The receiver operating characteristic curve for FDP showed 80% clinical sensitivity and 83% specificity with an optimal cut-off of 0.81 microg/mL, while that for CEA exhibited 84% sensitivity and 94% specificity with a cut-off of 3.51 ng/mL. The area under the curve was 0.87 and 0.96 for serum FDP and CEA, respectively. A combination of the two markers showed 90% clinical sensitivity and 92% specificity for colon cancer. CONCLUSIONS: The diagnostic sensitivity for colon cancer was increased by using a combination of FDP and CEA.

A Case of Hepatosplenic T-cell Lymphoma Diagnosed by Bone Marrow Examination

Hepatosplenic T-cell lymphoma (HSTL) is a condition in which lymphoma cells infiltrate the sinusoids of the liver, spleen, and bone marrow, without lymph node involvement. We encountered a case of hepatosplenic T-cell lymphoma in a Vietnamese woman. The patient was hospitalized with epigastric pain and nausea. Splenomegaly and multiple poorly defined, low-attenuating nodular lesions in the liver were visualized on computed tomography (CT), and thrombocytopenia was noted. The lymph nodes were not significantly enlarged. Splenic biopsy could not be performed because of severe thrombocytopenia. Neoplastic lymphoid cells were present in bone marrow aspirates. Bone marrow sections revealed infiltration of CD3(+) and CD20(-) neoplastic lymphoid cells in the sinusoids. A clonality assay (IdentiClone T-Cell Receptor Delta Gene Clonality Assay; Invivoscribe Technologies, USA) showed gene rearrangements in the T-cell receptor delta gene. Thus, we made a confirmatory diagnosis of HSTL. When splenic biopsy is not available, bone marrow aspirates and clonality assessment may become useful diagnostic tools.

A Case of Cimetidine-induced Immune Hemolytic Anemia / 대한수혈학회지

There have been 5 case reports about immune hemolytic anemia related with cimetidine, but there has been no such report in Korea. A sixty-four-year-old woman was admitted to the emergency department in a coma. She was diagnosed with diffuse large B-cell lymphoma 5 years ago and she achieved a complete remission after treatment. She was in a state of shock, and her blood pressure was 70/40 mmHg. The laboratory test results were consistent with hemolytic anemia (HA) as follows: hemoglobin: 1.9 g/dL, corrected reticulocyte count: 2%, total/conjugated bilirubin: 6.4/2.1 mg/dL, lactate dehydrogenase: 1,083 U/L and haptoglobin <10 mg/dL. She had a history of taking the drugs including cimetidine, acetaminophen and etizolam for two days. She urgently received transfusion of 3 units of packed red blood cells and then she regained consciousness. To investigate the relation between cimetidine and HA, we subsequently performed a drug-induced immune complex test and an antibody test by using cimetidine, AB serum and phosphate-buffered saline. The results proved that cimetidine was the cause of the HA. Patient was treated with steroid, and the following laboratory tests showed rapid improvement. This is the first case report from Korea that shows the causal relationship between cimetidine and immune HA.