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1.
Case Rep Oncol ; 13(3): 1397-1401, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33442362

RESUMO

Malignancies can trigger an autoimmune response against the nervous system and manifest as paraneoplastic neurological syndromes (PNS). Initial symptoms of PNS may develop up to 5 years prior to the diagnosis of the underlying malignancy. We report a rare case of PNS associated with transitional cell carcinoma of the bladder in a 70-year-old male with a 6-month history of rapidly progressive symmetric sensory neuropathy. Peripheral neuropathy serological workup was unremarkable. A paraneoplastic neuropathy panel revealed anti-Hu autoantibodies. Further evaluation with a whole-body PET scan could not identify the primary malignancy, but it showed hypermetabolic hilar lymph nodes. An endobronchial ultrasound biopsy of the hilar lymph nodes was negative for cancer. The patient developed painless hematuria 2.5 years after the onset of the sensory neuropathy. Cystoscopy with biopsy revealed non-muscle-invasive transitional cell carcinoma of the bladder. Progression of the sensory neuropathy stopped after tumor resection. This case highlights the importance of a diligent and systematic approach to diagnose PNS. A relentless search is often required to detect PNS-associated occult malignancies.

2.
Leuk Res Rep ; 12: 100179, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31388486

RESUMO

BACKGROUND: Sickle cell hemoglobinopathies are associated with end organ damage but very rarely present with a clinical and laboratory picture of microangiopathic hemolytic anemia (MAHA) and thrombocytopenia, characteristic of thrombotic microangiopathy (TMA). CASE PRESENTATION: We present a patient with HbSC disease who developed thrombotic microangiopathy, needing both RBC exchange transfusion and therapeutic plasma exchange (TPE) for complete clinical recovery. CONCLUSION: Although literature showed therapeutic plasma exchange alone can abrogate a similar clinical scenario, we did an in-depth review which concluded that in most of the TMA cases secondary to sickle cell disease, treatment with both with plasma exchange and red cell exchange transfusion are necessary.

3.
Leuk Res ; 79: 52-59, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30851544

RESUMO

Programmed Cell Death Receptor (PD-1) and its Ligand (PD-L1) pathway inhibitor therapy has been explored in the field of oncology treatment mainly for solid tumors. In hematologic malignancies, there is limited information except for Hodgkin's lymphoma, and there is even less information regarding myeloproliferative neoplasm (MPN). Therefore, we explored this by first measuring PD-1 and PD-L1 levels (percentage of positive cells) in 63 patients with Philadelphia chromosome-negative MPN (Ph(-) MPN), including 16 MF (12 PMF, 2 post-PV-MF, 2 post-ET-MF), 29 ET, and 18 PV. We found there was no significant difference in PD-1 or PD-L1 levels between the different MPN groups but that there was a significant difference when PV, ET and MF were grouped as MPN and compared with controls, of all immune cells including CD4+, CD8+, CD14+ and CD34+ progenitor cells. We further found a higher incidence of higher expression levels (more than 50% of cells with positive expression) of PD-1 and PD-L1 (20% and 26%, respectively) in the CD34+ cells; in contrast, we found a low incidence (0.08-1.8%) in the immune cells in MPN patients. PD-1 and PD-L1 levels were also measured by MFI methods, and we obtained similar results except the measurements by percentage appeared to be more sensitive than the MFI methods. We found no correlation between PD-1 and PD-L1 expression levels and clinical features including WBC, platelet counts, hemoglobin levels, presence or absence of the JAK2, MPL, or CALR gene mutation, or splenomegaly. Since MPN represents stem cell disorders, the presence of elevated expression of PD-1 and PD-L1 in these cells suggests that the exploration of PD-1 and PD-L1 pathway inhibitor therapy may be worthwhile in Ph(-) MPN.


Assuntos
Antígeno B7-H1/genética , Neoplasias Hematológicas/genética , Transtornos Mieloproliferativos/genética , Receptor de Morte Celular Programada 1/genética , Adulto , Idoso , Estudos de Casos e Controles , Feminino , Regulação Neoplásica da Expressão Gênica , Neoplasias Hematológicas/patologia , Humanos , Janus Quinase 2/genética , Masculino , Pessoa de Meia-Idade , Mutação , Transtornos Mieloproliferativos/patologia , Cromossomo Filadélfia
4.
J Hematol ; 8(4): 155-159, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32300463

RESUMO

Painless bleeding in a patient presenting from the community with elevated coagulation studies rarely makes the physicians suspect superwarfarin or rodenticide poisoning. Although a significant number of superwarfarin exposure cases are diagnosed every year, we believe there appears to be delay in diagnosis and confusion in determining what is the ideal way to treat and monitor these patients during the management. This is the first thorough literature review of all the reported cases of superwarfarin poisoning which also studied the clinical presentation, management and follow-up patterns. We present a 70-year-old man who presented to the emergency room with epistaxis, melena, cola-colored urine with elevated prothrombin time (PT), activated partial thromboplastin time (aPTT) and international normalized ratio (INR). Mixing studies showed complete correction of coagulopathy indicative of factor deficiency. Additional history revealed that the patient had arguments with family member at home and made us suspect superwarfarin exposure. Qualitative brodifacoum testing was positive and was managed with fresh frozen plasma and high doses of vitamin K1 (phytomenadione) with serial monitoring of INR and clinical symptoms. Superwarfarin poisoning should be considered in the differential diagnosis of a patient who presents with above clinical and laboratory profile especially in the absence of any history of coagulopathy or anticoagulant use. We want to raise public and especially physician awareness that history taking, early diagnosis and managing in right clinical setting play a significant role in survival of these patients.

5.
Am J Case Rep ; 19: 1074-1077, 2018 Sep 10.
Artigo em Inglês | MEDLINE | ID: mdl-30197412

RESUMO

BACKGROUND Ocular Kaposi's sarcoma (KS) involving the conjunctiva and ocular adnexa is uncommon and is usually treated with cryotherapy or surgical excision. We report a case of ocular KS successfully treated with HAART combined with 8 cycles of weekly docetaxel. CASE REPORT Our patient was a 24-year-old, treatment-naïve, HIV-positive (CD4 cell count 198 cells/mm3), homosexual man treated as having atypical hordeolum and subconjunctival hemorrhage, and later confirmed with pathology to have ocular KS with immunohistochemistry study showing KS with positive HHV8, CD34, CD31, and focal positive staining with Factor VIIIRA. HAART therapy was initiated combined with weekly docetaxel. With 2-month treatment of HAART and 8 cycles of weekly docetaxel, the KS of the bulbar conjunctiva and the eyelid partially resolved. CONCLUSIONS HAART combined with weekly docetaxel is an effective and well-tolerated option for ocular KS, which could be considered before cryotherapy or surgical excision.


Assuntos
Antirretrovirais/uso terapêutico , Antineoplásicos/uso terapêutico , Docetaxel/uso terapêutico , Neoplasias Oculares/tratamento farmacológico , Neoplasias Gengivais/tratamento farmacológico , Infecções por HIV/tratamento farmacológico , Sarcoma de Kaposi/tratamento farmacológico , Terapia Antirretroviral de Alta Atividade , Infecções por HIV/complicações , Humanos , Masculino , Sarcoma de Kaposi/etiologia , Adulto Jovem
6.
Future Oncol ; 8(11): 1487-93, 2012 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-23148621

RESUMO

This paper describes a rare case of germ cell cancer with duodenum, brain and lung metastases. The patient presented with melena and left testicle enlargement. Orchiectomy revealed mixed germ cell cancer, enteroscopy revealed duodenal choriocarcinoma, and chest x-ray and computed tomography (CT) showed bilateral lung metastases. The patient received and tolerated cisplatinum-based chemotherapy, and responded well. However, he developed seizures 3 months later. MRI showed brain metastases and he was treated with whole-brain radiation. One month later, he developed progressive dyspnea. Chest CT showed worsening lung metastases. He received second-line chemotherapy, but died due to multiorgan failure. Germ cell cancer with nonpulmonary metastases has poor prognosis and the management of these patients requires a multimodal approach. Head CT should be considered as routine screening for all germ cell cancer patients on initial diagnosis and brain MRI should be considered for high-risk patients (with an embryo- or choriocarcinoma histology, dramatically elevated ß-human chorionic gonadotropin and lung involvement).


Assuntos
Neoplasias Encefálicas/secundário , Hemorragia Gastrointestinal/etiologia , Neoplasias Embrionárias de Células Germinativas/complicações , Neoplasias Embrionárias de Células Germinativas/patologia , Neoplasias Testiculares/complicações , Neoplasias Testiculares/patologia , Adulto , Encéfalo/diagnóstico por imagem , Encéfalo/patologia , Neoplasias Encefálicas/diagnóstico , Neoplasias Duodenais/patologia , Neoplasias Duodenais/secundário , Humanos , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/secundário , Masculino , Radiografia , Adulto Jovem
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