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Non-Hodgkin lymphoma (NHL) is one of the most common hematological cancers in the United States. The mortality rate of NHL in the United States is the sixth highest among all cancers. Our cross-sectional study aims to examine the trends and disparity in NHL mortality. We analyzed death certificate data from the Centers for Disease Control and Prevention's Wide-Ranging Online Data for Epidemiologic Research (CDC WONDER) United States to determine the NHL mortality trends among the U.S. population aged ≥15 years. NHL (ICD-10 C82-85) was listed as the underlying cause of death. Age-adjusted mortality rates (AAMRs) per 100,000 individuals and joinpoint trend analysis were performed to determine the average annual percent change (AAPC) in AAMR trends. From 1999 to 2020, NHL accounted for 457,143 deaths in the United States, of which 54% are men and 46% are women. The NHL AAMR decreased significantly from 10.59 to 6.21 per 100,000 individuals with an AAPC of -2.55. Men had a higher AAMR than women (10.10 vs 6.29 per 100,000 individuals). Whites recorded the highest AAMR (8.43 per 100,000 individuals), followed by Hispanics (6.32 per 100,000 individuals), Blacks (5.71 per 100,000 individuals), American Indians (5.31 per 100,000 individuals), and Asians (5.10 per 100,000 individuals). Those who lived in the Midwest and the rural areas had the highest AAMR at 8.60 and 8.35 per 100,000 individuals respectively. Despite the declining NHL mortality rate, this study calls for targeted intervention to improve outcomes for susceptible individuals affected by NHL.
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Neoplasias Pulmonares , Tumores Neuroendocrinos , Humanos , Quinasa de Linfoma Anaplásico/genética , Neoplasias Pulmonares/tratamiento farmacológico , Neoplasias Pulmonares/patología , Inhibidores de Proteínas Quinasas/uso terapéutico , Inhibidores de Proteínas Quinasas/farmacología , Carbazoles/uso terapéutico , Carbazoles/farmacología , Pulmón/patologíaRESUMEN
Merkel cell carcinoma (MCC) is a rare, rapidly growing, and aggressive dermatological neoplasm. It is commonly reported in Caucasian ethnicities, and almost 50% of the patients have a concomitant malignancy and are on immunosuppressive chemotherapy. Here, we present a 79-year-old woman with a history of relapsed Stage II, grade III follicular lymphoma, receiving maintenance rituximab infusions. She presented with a raised erythematous papule on her left cheek. An excisional biopsy of the lesion confirmed a diagnosis of Merkel cell carcinoma. After which, she underwent a wider excision with 1-2 cm margins. PET scan did not reveal any FDG-avid uptake lesions that would be concerning for metastatic disease. However, she underwent a sentinel lymph node biopsy which was also negative. Thus, the diagnosis was finalized as Stage I (T1 N0 M0) MCC. There are only two reported cases in literature about the significant progression of Merkel cell carcinoma in patients who coincidentally were receiving rituximab as a part of treatment for another disease. This raises questions for future investigation and research on whether there is a direct association between rituximab use specifically and the rapid growth of MCC.
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Circulating tumour DNA (ctDNA) is defined as short DNA sequences shed by tumour cells into the systemic circulation. A promising use of ctDNA includes the detection of minimal residual disease (MRD) and is currently being studied in multiple types of solid tumours. Literature for the use of individualised ctDNA in nasopharyngeal carcinoma (NPC) is not available, although circulating Epstein-Barr virus DNA level is validated as a prognostic factor. We present a man in his 40s diagnosed with stage IV NPC who was started on chemotherapy with cis-platinum and gemcitabine. Serial monitoring of ctDNA completed to aid in detecting MRD after treatment demonstrated initial up-trending values correlating with subsequent imaging findings showing progression. Reinitiation of a different chemotherapy regimen significantly improved the ctDNA level, with corresponding imaging exhibiting a similar response. This case provides insight into the potential use of ctDNA in NPC and the benefit of serial ctDNA monitoring during treatment.
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ADN Tumoral Circulante , Infecciones por Virus de Epstein-Barr , Neoplasias Nasofaríngeas , Biomarcadores de Tumor/genética , Infecciones por Virus de Epstein-Barr/complicaciones , Infecciones por Virus de Epstein-Barr/diagnóstico , Herpesvirus Humano 4/genética , Humanos , Masculino , Carcinoma Nasofaríngeo , Neoplasias Nasofaríngeas/diagnóstico , Neoplasia ResidualRESUMEN
Thrombotic thrombocytopenic purpura (TTP) is a type of thrombotic microangiopathy that is characterized by microangiopathic haemolytic anaemia, consumption thrombocytopenia and organ injury. It is caused by a severe deficiency of ADAMTS13, which can be either congenital or acquired. There is a plethora of things that can cause the acquired form, including medications and infections. Vaccines have also been shown to cause TTP. In the midst of the COVID-19 pandemic, with multiple new vaccines being developed and distributed to the masses, the medical community needs to be aware of adverse events associated with these new vaccines. We present a case of TTP following administration of the Moderna booster vaccine.
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Anemia Hemolítica , COVID-19 , Púrpura Trombocitopénica Trombótica , Anemia Hemolítica/complicaciones , COVID-19/prevención & control , Humanos , Inmunización Secundaria/efectos adversos , Pandemias , Púrpura Trombocitopénica Trombótica/inducido químicamente , Púrpura Trombocitopénica Trombótica/complicacionesRESUMEN
INTRODUCTION: Triple-negative breast cancer (TNBC) in men is very rare. The clinical characteristics, prognostic factors, and overall survival of men with TNBC have not been characterized. METHODS: The study population consisted of men and women with a diagnosis of stage I-III TNBC between 2010 and 2016 in the National Cancer Database. Baseline demographic and tumor characteristics between men and women were compared using Pearson's Chi-Square test for categorical variables and Mann-Whitney U test for continuous variables. Kaplan-Meier and multivariate Cox proportional hazards regression model was used to compare survival and identify prognostic factors. RESULTS: A total of 311 men and 95,406 women with TNBC were included in the final analysis. The 3-year and 5-year overall survival was 74.8% and 68.8% in men, while it was 83.2% and 74.8% in women, respectively. In multivariate analysis, men were found to have a significantly worse overall survival compared to women (HR, 1.49, 95% CI, 1.19-1.86, P= .01). Older age at diagnosis, higher TNM stage, undergoing mastectomy and not undergoing chemotherapy or radiation were identified as independent negative prognostic factors in men with TNBC. CONCLUSION: In one of the largest studies of men with TNBC, men were noted to have a poorer overall survival compared to women, despite adjusting for usual prognostic factors. Further research into differences in tumor biology, treatment patterns and compliance with therapy between men and women are needed to understand the underlying etiologies for the survival difference in TNBC.
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Neoplasias de la Mama Masculina/mortalidad , Neoplasias de la Mama Masculina/patología , Neoplasias de la Mama Triple Negativas/mortalidad , Neoplasias de la Mama Triple Negativas/patología , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Pronóstico , Estudios Retrospectivos , Factores de Riesgo , Factores Sexuales , Resultado del TratamientoRESUMEN
Xp11.2 translocation renal cell carcinoma (TRCC) is a rare and aggressive variant of renal cell carcinoma (RCC) when presenting in adults. We report a case of a man in his early 40s who was diagnosed with stage III Xp11.2 TRCC and underwent radical nephrectomy. Seven months following the surgery, an adrenal nodule and bilateral pulmonary nodules were discovered. He underwent cryoablation of the adrenal nodule and systemic treatment with daily pazopanib. He displayed stable disease for approximately 6 years. Following this period, multiple hospitalisations interrupted daily pazopanib therapy resulting in progression of disease. His regimen was then changed to ipilimumab and nivolumab, followed by current daily therapy with axitinib. The patient now shows stable disease in his 10th year after diagnosis. This case study demonstrates the efficacy of pazopanib for metastatic Xp11.2 TRCC and warrants further investigation to supplement the guidelines regarding the use of targeted therapy for TRCC.
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Carcinoma de Células Renales , Neoplasias Renales , Adulto , Carcinoma de Células Renales/genética , Cromosomas Humanos X , Humanos , Indazoles , Neoplasias Renales/genética , Masculino , Pirimidinas , Sulfonamidas , Translocación GenéticaRESUMEN
A patient with a diagnosis of myelodysplastic syndrome (MDS) with isolated 5q deletion underwent repeat bone marrow biopsy to assess haematological response after 6 months of initial lenalidomide therapy. Subsequent bone marrow biopsies revealed persistent MDS with del(5q) in addition to a small atypical mast cell population with >25% of mast cells with spindle-shaped morphology and immunohistochemistry characteristics consistent with mastocytosis. Molecular testing on the bone marrow was positive for cKIT D816V and the patient was diagnosed with systemic mastocytosis (SM) with an associated haematological neoplasm. MDS with SM is well known to be associated; however, to the best of our knowledge, only one prior case report identifies MDS with del(5q) and associated cKIT D816V positive mastocytosis. While the exact clonal origin of both chromosomal aberrations is unclear, this case illustrates the therapeutic efficacy of lenalidomide in a patient with MDS with del(5q) and rarely associated cKIT positive SM.
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Anemia Macrocítica/complicaciones , Neoplasias Hematológicas/complicaciones , Mastocitosis/complicaciones , Síndromes Mielodisplásicos/complicaciones , Anemia Macrocítica/diagnóstico , Anemia Macrocítica/genética , Biopsia , Médula Ósea/patología , Deleción Cromosómica , Cromosomas Humanos Par 5/genética , Neoplasias Hematológicas/tratamiento farmacológico , Neoplasias Hematológicas/genética , Neoplasias Hematológicas/patología , Humanos , Factores Inmunológicos/administración & dosificación , Lenalidomida/administración & dosificación , Masculino , Mastocitosis/diagnóstico , Persona de Mediana Edad , Mutación , Síndromes Mielodisplásicos/tratamiento farmacológico , Síndromes Mielodisplásicos/genética , Síndromes Mielodisplásicos/patologíaRESUMEN
Catastrophic antiphospholipid syndrome (CAPS) is a rare but severe form of antiphospholipid syndrome (APS). The syndrome manifests itself as a rapidly progressive multiorgan failure that is believed to be caused by widespread micro-thrombosis. Seldom does bleeding comanifest with thrombosis. We present a patient with APS who presented with nausea, vomiting and fatigue, and rapidly progressed into multiorgan failure before being diagnosed with CAPS. The clinical course was complicated by an atraumatic intracranial haemorrhage which demanded discontinuation of anticoagulation. The patient was treated with high dose steroid, intravenous immunoglobulin, followed by weekly rituximab infusion. Although the trigger for CAPS was not obvious during her hospital stay, she was diagnosed with acute cytomegalovirus (CMV) infection soon after discharge. In this case report, we explore the differential diagnoses of CAPS, investigate the possibility of CMV infection as a potential trigger, present the therapeutic challenges of anticoagulation and discuss the emerging use of rituximab.
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Síndrome Antifosfolípido/complicaciones , Hemorragias Intracraneales/etiología , Adulto , Síndrome Antifosfolípido/tratamiento farmacológico , Enfermedad Catastrófica , Diagnóstico Diferencial , Femenino , Humanos , Inmunoglobulinas Intravenosas/uso terapéutico , Hemorragias Intracraneales/diagnóstico por imagen , Imagen por Resonancia Magnética , Rituximab/administración & dosificaciónRESUMEN
Fusion of b2a2 is the most common BCR/ABL rearrangement in CML; however, absent a2 exons are very rare. We describe a case with Philadelphia-positive chronic myeloid leukemia (CML) with a very rare b3a3 (e14a3) BCR/ABL junction. To our knowledge, only 15 such cases of CML have previously been reported. These uncommon transcripts may be under-reported, since RT-PCR-based assays may fail to detect these fusions due to the location of the primers and probes used. We are reporting this case for the first time which presented with MTHFR mutation and significant thrombocytosis. There is very limited information on how this genotype expresses and responds to treatment, especially to tyrosine kinase inhibitors, as compared to classic CML. Also, the relationship between MTHFR mutation and CML is not clear, although studies have been done.
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A label-free and reagent-free peptide mimotope capacitive biosensor has been developed for cancer drug (trastuzumab) quantification based on nonfaradic readout. The low sensitivity issue of capacitive biosensors was overcome with two innovations: peptide mimotope mixed self-assembled monolayer (SAM) biointerface and dilution of the analysis buffer. Signal amplification was achieved through dilution of phosphate-buffered saline (PBS) to tune Cdl to dominate the overall capacitance change upon target binding, which contribution is often negligible without dilution. After 1000× dilution, the limit of detection was lowered 500-fold (0.22 µg/mL) and the sensitivity was increased 20-fold [0.04192 (µg/mL)-1] in comparison with undiluted PBS. The proposed signal amplification strategy is more straightforward and practical compared to biorecognition element engineering and other strategies. The proposed method was further applied to planar electrodes for optimizing sensing response time to less than 1 min.
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Técnicas Biosensibles , Técnicas Electroquímicas , Inmunoensayo , Péptidos/química , Trastuzumab/análisisRESUMEN
Extrapulmonary small cell carcinomas (SCCs) are rare and often have an aggressive natural course. A 42-year-old female presented to the hospital with vaginal bleeding and lower abdominal pain. She was eventually diagnosed with SCC of cervix by biopsy. She was treated with chemoradiation. However, on follow-up positron emission tomography (PET) scan, fluorodeoxyglucose (FDG) uptake was noted in bilateral breasts. Biopsy of these lesions was consistent with metastatic SCC. Breast is a very unusual site for metastasis of cervical SCC and only four cases have been reported in the medical literature to date. Our case highlights the importance of considering metastatic disease when evaluating breast mass in patients with history of SCC of cervix.
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BACKGROUND: During induction treatment, acute myeloid leukemia patients may develop pulmonary infiltrates due to infectious or noninfectious etiologies. The risk association and the clinical outcome of such pulmonary infiltrates are poorly characterized in the literature. METHODS: We retrospectively reviewed 363 cases of acute myeloid leukemia patients who received induction therapy as inpatients over a period of 11 years at William Beaumont Health System. Of these 363 patients, 120 developed pulmonary infiltrates during induction therapy, those patients were divided into 2 groups based on distribution of the infiltrate presenting as localized or diffuse in nature. Data on patients characteristics, leukemia subtype, cytogenetic risk, microorganism type, white blood cell count at diagnosis, neutrophil count at the time the infiltrate was reported, response to antibiotic and/or antifungal therapy, using respiratory support, and mortality rate were retrieved through chart review. RESULTS: Thirty-three percent of patients developed pulmonary infiltrates during their induction therapy. Sixty-three patients (52.5%) had a localized infiltrates and 57 patients (47.5%) had diffuse infiltrates. Of the 120 patients with pulmonary infiltrates, 48 (40%) had at least 1 pathogenic microorganism identified, and 58 (48.7%) required intubation and ventilatory support. Patients with localized pulmonary infiltrates were more likely to have positive pathogenic microorganisms (68.3% vs. 8.8%, P<0.001), to be neutropenic (96.8% vs. 21%, P<0.001), and tended to have potentially reversible infiltrates after treatment (87.3% vs. 21%, P<0.001). Whereas patients with diffuse infiltrates were more like to require intubation (78.9% vs. 21%, P<0.001), to have leukocytosis (white blood cell >100 billions/L) at diagnosis (54.4% vs. 0%, P<0.001), and had a higher mortality rate (70.2% vs. 9.5%, P<0.001). CONCLUSIONS: The radiologic patterns of pulmonary infiltrates showed specific etiological and prognostic associations. Diffuse infiltrates are an unfavorable characteristic with overall dismal outcome.
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Quimioterapia de Inducción/efectos adversos , Leucemia Mieloide Aguda/tratamiento farmacológico , Leucemia Mieloide Aguda/patología , Enfermedades Pulmonares/etiología , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Intubación , Enfermedades Pulmonares/inducido químicamente , Enfermedades Pulmonares/microbiología , Masculino , Persona de Mediana Edad , Neutropenia/inducido químicamente , Respiración Artificial , Estudios Retrospectivos , Tirosina Quinasa 3 Similar a fms/genéticaAsunto(s)
Colecistitis/diagnóstico , Vesícula Biliar/patología , Linfoma de Células B Grandes Difuso/diagnóstico , Anciano de 80 o más Años , Colecistitis/complicaciones , Diagnóstico Diferencial , Resultado Fatal , Vesícula Biliar/irrigación sanguínea , Humanos , Linfoma de Células B Grandes Difuso/complicaciones , MasculinoRESUMEN
We report a rare case of haemorrhagic colitis attributed to dasatinib therapy in a 47-year-old African-American woman who was diagnosed with extramedullary T-lymphoblastic transformation of chronic myeloid leukaemia. The patient received intensive chemotherapy and dasatinib 100 mg/day. After achieving complete cytogenetic and major molecular response after 9 months of therapy, she developed bloody diarrhoea and pancytopenia. Colonoscopy showed inflammation of the descending colon and histopathology revealed patchy increase in intraepithelial lymphocytes. Dasatinib was stopped with prompt resolution of diarrhoea. The current literature suggests that there is an association in a subset of patients on dasatinib between clonal T-cell lymphocytosis in the peripheral blood and developing colitis and pleural effusions. These patients had a good response to dasatinib as did our patient. Our patient illustrates a unique disease presentation along with a rare drug adverse event.
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Colitis/inducido químicamente , Hemorragia Gastrointestinal/inducido químicamente , Leucemia Mielógena Crónica BCR-ABL Positiva/tratamiento farmacológico , Inhibidores de Proteínas Quinasas/efectos adversos , Pirimidinas/efectos adversos , Tiazoles/efectos adversos , Crisis Blástica/tratamiento farmacológico , Colon Descendente , Dasatinib , Diagnóstico Diferencial , Femenino , Humanos , Leucemia Mielógena Crónica BCR-ABL Positiva/patología , Persona de Mediana Edad , Resultado del TratamientoRESUMEN
A 46-year-old man with a long-standing history of Crohn's disease who was treated with multiple therapies over a period of 9 years presented with oral lesions which on biopsy demonstrated peripheral T-cell lymphoma. Initially, the development of T-cell lymphoma was presumed to be secondary to prolonged immunosuppression but it did not respond to withholding immunosuppressive therapy. On treatment with CHOP (cyclophosphamide, hydroxydaunorubicin, oncovin and prednisone) chemotherapy, complete remission was achieved. Although development of malignancies in the immune-suppressed patient with Crohn's disease has been previously described but we present a rare case of T-cell lymphoma in a similar patient, which has not been reported before.
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Enfermedad de Crohn/complicaciones , Enfermedad de Crohn/tratamiento farmacológico , Linfoma de Células T Periférico/complicaciones , Linfoma de Células T Periférico/tratamiento farmacológico , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Biopsia , Ciclofosfamida/uso terapéutico , Doxorrubicina/uso terapéutico , Humanos , Huésped Inmunocomprometido , Inmunosupresores/efectos adversos , Linfoma de Células T Periférico/inmunología , Masculino , Persona de Mediana Edad , Prednisona/uso terapéutico , Inducción de Remisión , Vincristina/uso terapéuticoRESUMEN
A man in his early 40s with a history of ulcerative colitis, treated with infliximab, was diagnosed with plasmablastic multiple myeloma. He was treated with chemotherapy and stem cell transplant but developed recurrence and ultimately died from metastatic disease. Could inflammatory bowel disease or infliximab therapy have any role in development of myeloma in this young patient? The role of inflammatory bowel disease and infliximab therapy in the development of multiple myeloma is controversial but interesting and worth considering.
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Anticuerpos Monoclonales/efectos adversos , Colitis Ulcerosa/complicaciones , Colitis Ulcerosa/tratamiento farmacológico , Mieloma Múltiple/etiología , Mieloma Múltiple/terapia , Recurrencia Local de Neoplasia/patología , Adulto , Anticuerpos Monoclonales/uso terapéutico , Antineoplásicos/uso terapéutico , Biopsia con Aguja , Colitis Ulcerosa/diagnóstico , Terapia Combinada , Progresión de la Enfermedad , Resultado Fatal , Trasplante de Células Madre Hematopoyéticas/métodos , Humanos , Inmunohistoquímica , Enfermedades Inflamatorias del Intestino/complicaciones , Enfermedades Inflamatorias del Intestino/diagnóstico , Enfermedades Inflamatorias del Intestino/tratamiento farmacológico , Infliximab , Masculino , Mieloma Múltiple/patología , Recurrencia Local de Neoplasia/fisiopatología , Medición de Riesgo , Índice de Severidad de la EnfermedadRESUMEN
BACKGROUND: We describe our experience of the case of a young female who presented with chest pain and was found to have an intra-pericardial mass that was later confirmed to be a paraganglioma. Although preoperative magnetic resonance imaging (MRI) did not show any left atrial invasion, the patient died in the peri-operative period due to irreparable damage of the cardiac structures from extensive neoplastic invasion. We then performed a retrospective analysis of the available literature to find the factors associated with adverse surgical and long-term outcomes in patients with cardiac paraganglioma. METHODS: We found 93 case reports of cardiac and/or pericardial paragangliomas in the literature. After exclusions, 82 cases were included in the final analysis. The patients were divided into two groups based on the outcome of surgical management. Univariate analysis was performed using SPSS software (Chicago, IL version 18), and the statistical significance was defined as a p-value<0.05. RESULTS AND CONCLUSIONS: The comparison of available demographic, clinical, pathological and laboratory parameters between the deceased and the surviving patients revealed that only the intra-cardiac location (p-value=0.021) and the development of metastases (p-value<0.001) were independently associated with increased surgical and long-term mortality, respectively. The size of a paraganglioma, its functional status or invasion into the surrounding structures does not appear to affect short-or long-term survival in these patients. The Kaplan-Meier survival curve showed excellent long-term prognosis for patients with a complete surgical removal of the neoplasm. Based on our experience, we also suggest preoperative imaging with a three dimensional cardiac CT and evaluation for cardiac transplantation before embarking on the surgical resection of these tumors.