ABSTRACT
We present the first known case of the monoblastic type of myeloid sarcoma (also known as extramedullary myeloid tumor, chloroma, and granulocytic sarcoma) with diffuse involvement of the gastrointestinal tract. The patient originally presented with diarrhea and crampy abdominal discomfort. Endoscopically, the disease showed a diffuse inflammatory process mimicking a number of benign conditions, such as inflammatory bowel disease and autoimmune enteropathy. Sequential biopsies of the upper and lower gastrointestinal tract showed a diffuse infiltrate of increasingly atypical cells. The disease progressed to systemic involvement, including widespread lymphadenopathy, splenomegaly, and pulmonary deposits; the patient died 13 months after the development of initial symptoms. The immunohistochemical and histologic profiles of this case are diagnostic of the monoblastic type of myeloid sarcoma.
Subject(s)
Gastrointestinal Neoplasms/diagnosis , Sarcoma, Myeloid/diagnosis , Diagnosis, Differential , Female , Gastrointestinal Neoplasms/pathology , Gastrointestinal Tract/pathology , Granulocyte Precursor Cells/pathology , Humans , Middle Aged , Sarcoma, Myeloid/pathologyABSTRACT
Infliximab is a novel biologic agent developed from recombinant technology now used widely in the treatment of Crohn's disease. It is effective in inducing and maintaining response in patients with moderate to severe luminal and fistulizing disease refractory to conventional therapy. Infliximab has also been shown to have a steroid-sparing effect. Although safe and generally well tolerated, the drug carries side effects that clinicians need to be able to recognize and to manage properly. Studies are underway to determine the best strategies to avoid antibodies to infliximab and to refine use of the agent.
Subject(s)
Antibodies, Monoclonal/therapeutic use , Crohn Disease/drug therapy , Fistula/drug therapy , Antibodies, Monoclonal/adverse effects , Antibodies, Monoclonal/economics , Crohn Disease/pathology , Fistula/pathology , Humans , InfliximabABSTRACT
Three domains are accepted components of the etiology of inflammatory bowel disease (IBD): genetic predisposition, environmental stimuli, and abnormal immune response. The latter two are reasonable targets for medical therapies in the near future, whereas all three merit consideration for the more distant future as techniques of genetic manipulation evolve. In this review we summarize some of the fundamental concepts and offer comments on treatments for IBD that are likely and desirable in the near and distant future.