ABSTRACT
Pheochromocytoma originates from the chromaffin cells of the adrenal medulla. It produces an excess of catecholamines. It is essentially a benign tumour, and the malignant type represents a minority. The malignant behaviour can be unclear in the absence of metastases. Factors of poor prognosis in malignant pheochromocytoma include male sex, old age, large-sized tumours, the presence of metastases at the time of diagnosis and non-surgical treatment. The cornerstone treatment of pheochromocytoma is surgical excision. In the presence of metastases, chemotherapy can control the symptoms and prolong survival. Its reported side effects are usually few and mild. This report presents a rare case of malignant pheochromocytoma in a 26-year-old gentleman that first manifested as a hypertensive urgency. The patient had several recurrences and multiple metastases despite two surgical excisions. Such poor outcome could not be predicted initially by the known risk factors. A non-previously reported complication of treatment was acute lower limb ischaemia after the start of chemotherapy for the tumour, depriving the patient of completing the course. In conclusion, the presence of hypertension in young adults warrants the investigation for pheochromocytoma. Postoperative follow-up is mandatory to pick up early signs of malignancy and metastasis. Tumour breakdown by chemotherapy can cause various cardiovascular problems including acute limb ischaemia. The management can be quite challenging, therefore, a multidisciplinary team should look after the case. A palliative approach can be used in patients with severe symptoms and no chance of cure.
ABSTRACT
Colorectal non-Hodgkin lymphoma (NHL) is quite aggressive and rare, only constituting less than 1% of all cases of colorectal cancer. The pericardium is an extremely rare first site of metastasis. Cardiac tamponade can be a life-threatening initial presentation. We report a 55-year-old female who presented with severe shortness of breath, intermittent abdominal pain and altered bowel habits. She had low blood pressure with congested neck veins. Her echocardiogram showed pericardial and cardiac infiltration with tumour mass; a large pericardial effusion with signs of cardiac tamponade. There was no safe window for percutaneous drainage, and the patient was not physically fit for surgical drainage. A multidisciplinary approach was used to diagnose and manage the case involving a cardiologist, gastroenterologist, pathologist, radiologist and oncologist. CT scans of the whole body showed a large rectosigmoid mass infiltrating the uterus and adnexa. Flexible sigmoidoscopy showed a large bleeding mass at the rectosigmoid junction. The biopsy confirmed small cell NHL. Three cycles of chemotherapy were urgently commenced over a period of 5 weeks (1 cycle of CVP; 2 cycles of CHOP). The patient showed significant symptomatic improvement. A 5-week follow-up echocardiogram showed significant shrinkage of the pericardial tumour and only a small rim of pericardial effusion. The effusion did not recollect in her follow-up echocardiograms. A year later, she was referred to the palliative care team due to the further spreading of her lymphoma. In conclusion, colorectal small cell NHL may initially present as cardiac tamponade. Urgent initiation of chemotherapy can be a treatment option whenever a drainage procedure is unsafe. LEARNING POINTS: Colorectal small cell NHL is a quite rare malignancy that may present initially with pericardial metastasis.Cardiac tamponade secondary to colorectal NHL is a life-threatening presentation. It can be managed by timely chemotherapy alone whenever the usual drainage procedures are not safe.A multidisciplinary approach is a cornerstone in the management of unstable lymphoma patients. It helps the rapid diagnosis and initiation of appropriate chemotherapy.
ABSTRACT
DNA methylation is an epigenetic mechanism used by cells to control gene expression. DNA methylation is a commonly used epigenetic signaling tool that can hold genes in the "off" position. Chronic infection with hepatitis C virus (HCV) is considered a major risk for chronic liver impairment. It is the most common leading cause of HCC. The present work is aimed at studying whole genome 5'-methylcytosine levels in cirrhotic HCV-infected Egyptian patients. In the present study, 120 Egyptian adults were included. They were divided into two groups: group Ð (40 apparently healthy control subjects) and group ÐÐ (80 HCV-infected patients). Furthermore, group II was subdivided into 2 subgroups according to the presence of HCC in HCV-infected subjects. To all studied subjects, the level of 5-mC% was measured in peripheral blood. In the present study, the median of 5'-methylcytosine% in the control group (group I) was 2.5, in the HCV group (group IIa) was 2.45, and in the HCC group (group II b) was 2.25. A stepwise decrease in 5'-methylcytosine% from the control (group I) toward HCC (group IIb) was observed, taking into consideration that the stepwise global hypomethylation was not statistically significant (p = 0.811). There was a negative correlation between ALT and 5'-methylcytosine% (p = -0.029). From this study, we can conclude that global DNA 5'-methylcytosine% does not differ in HCV-infected cirrhotic patients and HCC patients when compared to normal controls. Consecutively, we had concluded that there is no impact of 5'-methylcytosine% on the development of liver cirrhosis or HCC. Moreover, the negative correlation between 5'-methylcytosine% and serum ALT level denotes a trend of decrease in 5'-methylcytosine% with more liver damage.
