Diagnostic value of the neutrophil/lymphocyte ratio, platelet/lymphocyte ratio, and thrombocytosis in the preoperative investigation of ovarian masses / Valor diagnóstico das razões neutrófilo/linfócito, plaqueta/ linfócito, e trombocitose na investigação pré-operatória de massas ovarianas

Abstract Objective To evaluate the diagnostic accuracy of cancer antigen 125 (CA125) and complete blood count (CBC) parameters, such as the neutrophil to lymphocyte ratio (NLR), the platelet to lymphocyte ratio (PLR), and thrombocytosis in patients with ovarian masses. Methods The present is a retrospective study conducted at a single tertiary hospital from January 2010 to November 2016. We included consecutive women referred due to suspicious adnexal masses. The CBC and CA125 were measured in the serum of 528 women with ovarian masses before surgery or biopsy. We evaluated the diagnostic performance of the NLR, PLR, platelets (PLTs), CA125, and the associations between them. We tested the clinical utility of the CBC parameters and CA125 in the discrimination of ovarian masses through decision curve analysis (DCA). Results The best balance between sensitivity and specificity was obtained by the associations of CA125 or PLTs ≥ 350/nL, with 70.14% and 71.66%, CA125 or PLTs ≥ 400/ nL, with 67.30% and 81.79%, CA125 or PLR, with 76.3% and 64.87%, and CA125 or NLR, with 71.09% and 73.89% respectively. In the DCA, no isolated CBC parameter presented a higher clinical utility than CA125 alone. Conclusion We showed that no CBC parameter was superior to CA125 in the prediction of the malignancy of ovarian tumors in the preoperative scenario.

Resumo Objetivo Avaliar a acurácia diagnóstica do antígeno de câncer 125 (cancer antigen 125, CA125, em inglês) e dos parâmetros do hemograma como as razões neutrófilo/linfócito (RNL), plaqueta/linfócito (RPL), e trombocitose em pacientes com massas ovarianas. Métodos Este é um estudo retrospectivo realizado em um hospital terciário no período de janeiro de 2010 a novembro de 2016. Foram incluídas de forma consecutiva mulheres encaminhadas por massas anexiais suspeitas. Foram dosados hemogramas e CA125 no soro de 528 mulheres com massas ovarianas antes da cirurgia ou biópsia. Foram avaliados os desempenhos diagnósticos da RNL, da RPL, das plaquetas (PLQs) e do CA125, considerando-os isoladamente e associados entre si. Testamos a utilidade clínica dos parâmetros do hemograma e do CA125 na discriminação das massas ovarianas por análise de curva de decisão (ACD). Resultados Os melhores equilíbrios entre sensibilidade e especificidade foram obtidos por meio das associações do CA125 ou PLQs ≥ 350/nL, com 70,14% e 71,66%, CA125 ou PLQs ≥ 400/nL, com 67,30% e 81,79%, CA125 ou RPL, com76,3% e 64,87%, e CA125 ou RNL, com 71,09% e 73,89%, respectivamente. Conclusão Na ACD, nenhum parâmetro do hemograma isolado se mostrou superior ao CA125 na predição de malignidade de tumores ovarianos no pré-operatório.

Síndrome POEMS: a propósito de un caso y revisión de la literatura / POEMS syndrome: report of a case and review of literature

El síndrome POEMS es un síndrome paraneoplásico raro asociado a discrasia de células plasmáticas. Se presenta el caso de un paciente masculino de 37 años de edad, quien consultó por presentar de 38.5 C°, precedida de escalofríos, predominio nocturno y frecuencia diaria/interdiaria, de tres meses de evolución; concomitante parestesias en región plantar bilateral, ascendente, con disminución de fuerza muscular simétrica en miembros inferiores. Durante su estancia hospitalaria se evidencia trombocitosis y eritrocitosis. Se realizó ecosonograma abdominal que evidencia hepatomegalia; tomografía computarizada (TC) de cuello que reportó adenopatías submandibulares, laterocervicales y parayugulares; TC de tórax donde se evidencia lesión ocupante de espacio de características osteolíticas expansivas a nivel de segunda costilla izquierda; electromiografía de miembros superiores e inferiores con radiculopolineuropatía de tipo mixto en miembros inferiores y polineuropatía sensitivo motora de tipo mixto en miembros superiores; electroforesis de proteínas con discreto aumento de gammaglobulinas, a expensas de IgG y aspirado de médula ósea con serie plasmática aumentada (3%) de apariencia madura. Se realizó biopsia de lesión en segundo arco costal izquierdo sin evidenciar atipias. En vista de hallazgos clínicos y paraclínicos se planteó síndrome POEMS.

POEMS syndrome is a rare paraneoplastic syndrome due to an underlying plasma cell disorder. We present a male patient of 37 years old with fever 38.5°C, preceded by chills, nocturnal predominance and daily frequency of three months of evolution, as well as paresthesias in plantar region, bilateral, ascendant with decrease in muscle strength of legs. During his hospitalization, he presented thrombocytosis and erythrocytosis. The abdominal ecosonography evidenced hepatomegaly; thorax computerized tomography evidenced space osteolytic occupying lesion in second left rib. The electromyography demonstrated radiculo polineuropathy in legs, and sensory motor polineuropathy in upper limbs. The protein electrophoresis with elevated of gammaglobulins ;bone marrow aspirate evidenced (3%) mature increased plasma cells. The biopsy of second rib evidenced no atypia.

Transient thrombocytosis with megathrombocytes in a case of acute myeloblastic leukemia.

Thrombocytosis is commonly seen in reactive conditions and certain neoplastic states, such as chronic myeloproliferative disorders. It is rarely seen in acute leukemia. A 12-year-old girl with acute myeloblastic leukemia (FAB M2) in remission presented with pyoderma. Her hemogram revealed anemia (Hb-6.4g/dl), leucopenia (TLC - 1.2 x 109/L) and thrombocytosis (platelet count- 580 x 109/L). A peripheral blood film showed numerous abnormally large platelets with few atypical cells. The thrombocytosis subsided with the clearance of infection but atypical cells persisted. One month later, she relapsed. Cytogenetic analysis revealed variable results (trisomy 9 and deletion 3). This case has been presented because thrombocytosis is rare in AML and its appearance calls for a close follow-up.