Burkitt Lymphoma of the Appendix Presenting With Acute Appendicitis and Acute Kidney Injury: A Case Report and Review of Literature.

The gastrointestinal tract is one of the most common sites for extranodal Burkitt lymphomas (BLs), but an appendiceal BL is extremely rare. We describe a case of appendiceal BL presenting with acute appendicitis and acute kidney injury. A 15-year-old obese male presented to the emergency department with fever and right-sided abdominal pain. WBC count was slightly increased, and a CT scan of the abdomen showed features of ruptured appendicitis and peritonitis. The patient was placed on antibiotics, and an interval appendectomy was planned. The patient developed a worsening acute kidney injury one day later, requiring a laparoscopic appendectomy. Gross examination of the appendix revealed a dilated, firm, sausage-like appendix with a hemorrhagic serosa and a firm mesoappendix. Microscopic examination of the appendix showed a dense diffuse infiltration of monomorphic medium-sized atypical lymphoid cells with round nuclei, dispersed chromatin, and small nucleoli. Few scattered macrophages created a vague "starry sky" appearance. Many mitotic figures were seen. The lesion also involved the mesoappendix. Immunohistochemical analysis showed that the lymphoma expressed CD10, CD20, and BCL6 but was negative for CD34, BCL2, and TdT. Later, the fluorescence in situ hybridization (FISH) analysis detected an IGH-MYC (8;14) fusion. A final diagnosis of appendicular Burkitt lymphoma was made. Two weeks later, a bone marrow biopsy performed for staging showed involvement of bone marrow by BL. The patient lost follow-up after that due to the transfer of care to another hospital.

A Rare Association: Autoimmune Hemolytic Anemia With Indolent T-Cell Prolymphocytic Leukemia.

The association of warm autoimmune hemolytic anemia (wAIHA) with various lymphoproliferative disorders is well reported in the literature. But the association of wAIHA with T-cell prolymphocytic leukemia (T-PLL), a very rare lymphoproliferative disorder, has never been reported. A 71-year-old man was in his usual state of health until three years ago when he developed intermittent bouts of worsening anemia associated with mild peripheral blood lymphocytosis. He was diagnosed with wAIHA and steroid therapy was initiated, resulting in an improvement in the hemoglobin level of the patient. His lymphocyte count remained persistently elevated but he did not develop any malignancy-related signs or symptoms. A diagnosis of 'indolent' T-cell prolymphocytic leukemia (small cell variant) was made by combining distinctive clinical, morphologic, immunophenotypic, and cytogenetic analysis. His wAIHA went into complete remission and steroid therapy was successfully tapered off. He has not required any treatment for his T-PLL during the last two years' follow-up.

Influences for Gender Disparity in Academic Psychiatry in the United States.

Introduction Academic undertakings, including research, lead to career progression. However, the career paths of female psychiatrists appear to diverge significantly from that of their male counterparts. This article reviews the pervasiveness of the trend of women being less likely to pursue active research in psychiatry. In addition, we examine the correlation between academic rank and research productivity. Methods We searched the American Medical Association's (AMA) Fellowship and Residency Electronic Interactive Database (FREIDA) to identify training programs for psychiatry. A total of 5234 psychiatrists met our inclusion criteria. The gender, academic rank, research work, and h-index of faculty members were compared. The ratio of women reaching senior ranks as compared to men was also calculated. The Scopus database was used to determine the h-index of the individuals included in this study. Data analysis was done with SPSS 22.0 Release 2013 (IBM SPSS Statistics for Windows, IBM, Armonk, NY, USA). Kruskal-Wallis and Mann-Whitney U tests were used where required, with the P-value set at less than 0.05. Results In our study sample, 2181 (42%) of the psychiatrists were women. However, according to the information obtained from the websites of 23 programs, few women reached higher ranks, full professorship, or positions such as the chairperson of a program, and only 9% of women achieved the designation of chairperson of the psychiatry department, with men representing the other 91%. Higher academic rank correlated with higher h-index. A statistically-significant difference between the genders in terms of h-index was found for the assistant professor rank as well. However, this difference was not observed at the level of an associate professor. Conclusions Despite adequate representation of women in the academic workforce in psychiatry, there appears to be a discrepancy in the research productivity of the two genders. This study highlights the need for targeted interventions to address gender disparities in academic psychiatry.