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1.
Transplant Direct ; 9(8): e1500, 2023 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-37456590

RESUMO

Liver allografts protect renal allografts from the same donor from some, but not all, preformed donor specific alloantibodies (DSA). However, the precise mechanisms of protection and the potential for more subtle alterations/injuries within the grafts resulting from DSA interactions require further study. Methods: We reevaluated allograft biopsies from simultaneous liver-kidney transplant recipients who had both allografts biopsied within 60 d of one another and within 30 d of DSA being positive in serum (positive: mean florescence intensity ≥5000). Routine histology, C4d staining, and specialized immunohistochemistry for Kupffer cells (KCs; CD163) and a C4d receptor immunoglobulin-like transcript-4 were carried out in 4 patients with 6 paired biopsies. Results: Overt antibody-mediated rejection was found in 3 of 4 renal and liver allografts. One patient had biopsy-confirmed renal and liver allograft antibody-mediated rejection despite serum clearance of DSA. All biopsies showed KC hypertrophy (minimal: 1; mild: 2; moderate: 1; severe: 2) and cytoplasmic C4d KC staining was easily detected in 2 biopsies from 2 patients; minimal and negative in 2 biopsies each. Implications of which are discussed. Control 1-y protocol liver allograft biopsies from DSA- recipients showed neither KC hypertrophy nor KC C4d staining (n = 6). Conclusions: Partial renal allograft protection by a liver allograft from the same donor may be partially mediated by phagocytosis/elimination of antibody and complement split products by KCs, as shown decades ago in controlled sensitized experimental animal experiments.

2.
Proc (Bayl Univ Med Cent) ; 35(2): 252-253, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35261471

RESUMO

Myeloid sarcoma is a tumor mass of immature myeloid or monocytic cells (rarely erythroid or megakaryocytic) occurring in an extramedullary site. A de novo promyelocytic granulocytic sarcoma is a very rare tumor. We report a case of a young man presenting with a paraspinal myeloid sarcoma of promyelocytic origin.

4.
Surg Neurol Int ; 11: 204, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32874707

RESUMO

BACKGROUND: Primary angiosarcoma (AS) of the central nervous system (PACNS) is an extremely rare malignancy. The meninges represent an uncommon site of origin of PACNS. This report describes a recurrent meningeal PACNS treated with surgery, radiotherapy, stereotactic radiosurgery, and paclitaxel at different stages of the disease. CASE DESCRIPTION: A 36-year-old Asian male presented to our facility with a 4-month history of worsening headaches and complete right homonymous hemianopia. Neuroimaging revealed a left occipital lobe hematome with an underlying left tentorial tumor. After subtotal resection, neuropathological examination revealed features of a malignant endothelial cell AS. He received a course of adjuvant radiation therapy but experienced disease progression. He subsequently received additional stereotactic radiosurgery followed by weekly paclitaxel. Magnetic resonance imaging during the course of treatment revealed stable disease until patient died following another progression of his tumor. CONCLUSION: This case of a meningeal PACNS highlights the importance of considering this entity in the face of a malignant lesion presenting with intracranial hemorrhagic activity. Our observations suggest that the use of paclitaxel provided a modest clinical response in PACNS, highlighting the need to consider a combined approach structured mainly on surgery and radiotherapy. Stereotactic radiosurgery appears to be a promising treatment option.

5.
J Neurol Surg Rep ; 81(1): e7-e9, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32206542

RESUMO

Introduction Textiloma (Txm) is a nonmedical term that has been given to foreign body-related inflammatory pseudotumor arising from retained nonabsorbable cotton matrix that is either inadvertently or deliberately left behind during surgery, which may trigger an inflammatory reaction. This report describes a case of Txm mimicking a recurrent high-grade astrocytoma. Case Report We, here, present the case of a 69-year-old female with a 6-month history of progressive left-sided weakness. Neuroimaging studies revealed a large nonenhancing mass in the right frontoparietal lobe. Pathology reported a World Health Organization tumor classification grade II, diffuse astrocytoma. After surgical intervention, external beam radiation was given to the remaining areas of residual tumor. Routine magnetic resonance imaging (MRI) revealed a nodular area of contrast enhancement in the dorsal and inferior margin of the biopsy tract, growing between interval scans, and perfusion-weighted imaging parameters were elevated being clinically asymptomatic. She underwent a complete resection of this area of interest and pathology returned as a Txm with Surgicel fibers. Conclusion After treatment of a neoplasm, if unexpected clinical or imaging evidence of recurrence is present, a foreign body reaction to hemostatic material used during the initial surgery should be included in the differential diagnosis.

6.
Proc (Bayl Univ Med Cent) ; 33(1): 69-70, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32063776

RESUMO

Extramedullary hematopoiesis (EMH) is a well-known phenomenon occurring during fetal development. In the postfetal condition, EMH is commonly associated with hematologic conditions including chronic myeloproliferative or lymphoproliferative disorders, leukemias, and chronic and inherited anemias. We report an unusual location for EMH that masqueraded as a cranial tumor.

7.
Cancer Res ; 78(18): 5243-5258, 2018 09 15.
Artigo em Inglês | MEDLINE | ID: mdl-30012670

RESUMO

Inflammation affects tumor immune surveillance and resistance to therapy. Here, we show that production of IL1ß in primary breast cancer tumors is linked with advanced disease and originates from tumor-infiltrating CD11c+ myeloid cells. IL1ß production is triggered by cancer cell membrane-derived TGFß. Neutralizing TGFß or IL1 receptor prevents breast cancer progression in humanized mouse model. Patients with metastatic HER2- breast cancer display a transcriptional signature of inflammation in the blood leukocytes, which is attenuated after IL1 blockade. When present in primary breast cancer tumors, this signature discriminates patients with poor clinical outcomes in two independent public datasets (TCGA and METABRIC).Significance: IL1ß orchestrates tumor-promoting inflammation in breast cancer and can be targeted in patients using an IL1 receptor antagonist. Cancer Res; 78(18); 5243-58. ©2018 AACRSee related commentary by Dinarello, p. 5200.


Assuntos
Neoplasias da Mama/metabolismo , Regulação Neoplásica da Expressão Gênica , Proteína Antagonista do Receptor de Interleucina 1/metabolismo , Interleucina-1beta/metabolismo , Transcrição Gênica , Animais , Neoplasias da Mama/tratamento farmacológico , Antígeno CD11c/metabolismo , Capecitabina/administração & dosagem , Linhagem Celular Tumoral , Membrana Celular/metabolismo , Feminino , Furanos/administração & dosagem , Humanos , Inflamação , Proteína Antagonista do Receptor de Interleucina 1/administração & dosagem , Cetonas/administração & dosagem , Leucócitos Mononucleares/citologia , Macrófagos/metabolismo , Camundongos , Camundongos SCID , Células Mieloides/metabolismo , Metástase Neoplásica , Transplante de Neoplasias , Paclitaxel/administração & dosagem , Projetos Piloto , Fator de Crescimento Transformador beta/metabolismo
8.
Proc (Bayl Univ Med Cent) ; 30(1): 99-100, 2017 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-28127151

RESUMO

Focal myositis is a rarely reported inflammatory disease of skeletal muscle, particularly of an extremity. It is often misinterpreted as an infectious syndrome, leading to prolonged antibiotic use and a delay in immunosuppressive therapy. Without a confirmed etiology to date, we present a case of recurrent focal myositis following an electromyogram.

9.
J Natl Compr Canc Netw ; 14(11): 1345-1350, 2016 11.
Artigo em Inglês | MEDLINE | ID: mdl-27799506

RESUMO

BACKGROUND: Gangliogliomas are slow-growing, low-grade central nervous system tumors affecting children and young adults. However, some patients will experience tumor recurrence and/or malignant progression. This article reports on the clinical history, molecular findings, and treatment response in a patient with BRAF V600-mutated high-grade glioma arising from ganglioglioma. METHODS: Hematoxylin-eosin staining and comprehensive genomic profiling via Foundation One were performed on the tumor sample from a male patient undergoing treatment at the Department of Neuro-Oncology at Baylor University Medical Center. RESULTS: The patient was eligible for participation in a clinical trial (ClinicalTrials.gov identifier: NCT00916409) of a tumor treatment fields (TTFields) device, NovoTTF-100A, with concurrent radiation and chemotherapy (CCRT). His disease relapsed 4 months after completion of his CCRT, with MRI showing areas of enhancement. Temozolomide was discontinued and he was offered dabrafenib, an oral selective inhibitor of BRAF V600E, with continued use of NovoTTF. At the time of this report, after 2 years of treatment with dabrafenib and TTFields, the patient shows a durable complete response in all areas with no active lesions or new areas of enhancement. CONCLUSIONS: This report suggests that TTFields delivered in combination with targeted therapy dabrafenib yielded a remarkable clinical and radiologic response in this recurrent high-grade glioma. Targeted therapy matched to genomic alterations combined with TTFields treatment could provide clinical benefit and should be prospectively explored in the near future.


Assuntos
Antineoplásicos/uso terapêutico , Ganglioglioma/complicações , Glioma/tratamento farmacológico , Imidazóis/uso terapêutico , Oximas/uso terapêutico , Proteínas Proto-Oncogênicas B-raf/genética , Adulto , Antineoplásicos/administração & dosagem , Antineoplásicos/farmacologia , Ganglioglioma/patologia , Glioma/patologia , Humanos , Imidazóis/administração & dosagem , Imidazóis/farmacologia , Masculino , Mutação , Gradação de Tumores , Oximas/administração & dosagem , Oximas/farmacologia , Adulto Jovem
10.
Proc (Bayl Univ Med Cent) ; 28(3): 291-5, 2015 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-26130870

RESUMO

West Nile virus (WNV) has been responsible for multiple outbreaks and has shown evolution in its clinical manifestation. The Centers for Disease Control and Prevention has provided diagnostic criteria in classifying the variety of WNV infection; however, application of these criteria can prove challenging during outbreaks, and understanding the array of presentations and patient population is clinically important. In this article, we present the challenges encountered during the 2012 outbreak at one institution.

11.
Proc (Bayl Univ Med Cent) ; 27(4): 331-3, 2014 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-25484501

RESUMO

Sudden death from intracerebral hemorrhage was observed in two patients admitted to Baylor University Medical Center at Dallas in a single month. Each had been drinking alcohol at the time of onset of first symptoms. Intracerebral hemorrhage was diagnosed in one patient by computed tomography, but not in the second patient who clinically was diagnosed as having acute coronary syndrome. Both died within 24 hours of onset of symptoms, and autopsy in both disclosed intracerebral hemorrhage, an infrequent cause of sudden death. This report calls attention to intracerebral hemorrhage as a cause of sudden death.

12.
Proc (Bayl Univ Med Cent) ; 26(1): 52-4, 2013 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-23382616

RESUMO

Subependymomas are rare, slow-growing benign neoplasms. Although most are asymptomatic, they can present with symptoms related to increased intracranial pressure and hydrocephalus. We describe a 47-year-old man with worsening headaches who was found to have a subependymoma, with a focus on the imaging findings, differential diagnoses, pathology, and treatment.

13.
Proc (Bayl Univ Med Cent) ; 25(1): 23-5, 2012 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-22275778

RESUMO

Rupture of an intracranial dermoid cyst is a rare event with considerable associated morbidity and potential mortality. We present a case of intracranial rupture of a dermoid cystic tumor with consequent dissemination of subarachnoid fat droplets resulting in acute aseptic chemical meningitis. Radiographic findings, operative treatment, and pathologic features are described.

14.
Proc (Bayl Univ Med Cent) ; 23(4): 429-31, 2010 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-21240328

RESUMO

Meningiomas are common tumors of the central nervous system that account for approximately 15% of all intracranial tumors and are the most common extra-axial neoplasm. Most meningiomas are benign, although atypical and malignant meningiomas also exist. Typical imaging characteristics include a well-circumscribed, homogeneously enhancing, extra-axial mass on both computed tomography and magnetic resonance imaging. The presence of an associated cyst is an uncommon imaging feature that may make it difficult to distinguish the tumor from a primary intra-axial glial neoplasm. The presence of peritumoral edema can also be a misleading finding. We present a case of a woman who presented with a history of multiple recent falls, decreased energy, and increased somnolence and was found to have a "cystic meningioma." Typical imaging characteristics, histologic subtypes, treatment, and prognosis are also discussed.

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