RESUMEN
ABSTRACT: A chemoport is widely used in paediatric oncology population. Removal is a relatively easy procedure, but difficulty can be encountered in case the catheter is densely adherent to the vascular wall. It is a rare complication and is associated with long indwelling duration and acute lymphoblastic leukaemia (ALL). Forceful traction can lead to vascular injury and high morbidity. Herein, we report a 7-year-old girl with precursor B ALL who had delayed chemoport removal due to the coronavirus disease (COVID-19) pandemic. The removal process was difficult, as the catheter was adherent to the right innominate vein. Out of panic, the surgeon pulled it out forcefully. Fortunately, the catheter and its fragment were successfully retrieved completely and the child was discharged the next day. The management strategy varies and ranges from minimally invasive to open surgery. Leaving a stuck chemoport catheter in situ can be a bailout method or part of conservative management.
Asunto(s)
COVID-19 , Remoción de Dispositivos , Humanos , Niño , Femenino , Catéteres de Permanencia/efectos adversos , SARS-CoV-2 , Cateterismo Venoso Central/efectos adversos , Leucemia-Linfoma Linfoblástico de Células Precursoras B/terapia , Leucemia-Linfoma Linfoblástico de Células Precursoras B/cirugía , PandemiasRESUMEN
HistoryAn 18-year-old man was diagnosed with precursor B-cell lymphoblastic leukemia and underwent transplantation of hematopoietic stem cells from his human leukocyte antigen-matched sister 1 year prior to admission. He was admitted to evaluate progressive shortness of breath and dry cough of 1-month duration. He did not report fever, night sweats, or hemoptysis. Physical examination revealed he was afebrile and had normal pulse oxygen saturation. The examination revealed crepitation on palpation of the anterior neck, expiratory wheezes, and crackles heard at auscultation of bases of both lungs. Extensive maculopapular rash on the skin was consistent with graft-versus-host disease (GVHD). Laboratory tests revealed elevated liver transaminase and bilirubin levels that were attributed to liver GVHD. Nonenhanced thin-section CT of the chest was performed.
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Enfermedad Injerto contra Huésped , Trasplante de Células Madre Hematopoyéticas/efectos adversos , Enfisema Pulmonar , Enfisema Subcutáneo , Adolescente , Disnea , Humanos , Masculino , Leucemia-Linfoma Linfoblástico de Células Precursoras B/cirugía , Enfisema Pulmonar/diagnóstico por imagen , Enfisema Pulmonar/etiología , Enfisema Subcutáneo/diagnóstico por imagen , Enfisema Subcutáneo/etiología , Tomografía Computarizada por Rayos XRESUMEN
Acute lymphoblastic lymphoma is a malignant hematologic disease in childhood but rarely initially involves epidural compartment in adults. A 20-year-old male presented with progressive osphyalgia with constipation. Contrasted magnetic resonance imaging showed multiple vertebrae of hypointense T1 signals and an intraspinal epidural lesion. Subtotal resection was achieved. Histopathology suggested malignant B-cell lymphoma with Ki-67 of 90% and positivity of leukocyte common antigen. A bone marrow biopsy was unequivocally diagnostic of B-cell acute lymphoblastic lymphoma followed by chemotherapy (methotrexate) and partial recovery was observed. The marrow biopsy was necessary if without hypercalcemia and abnormal peripheral blood examination.
Asunto(s)
Leucemia-Linfoma Linfoblástico de Células Precursoras B/cirugía , Neoplasias de la Columna Vertebral/cirugía , Columna Vertebral/cirugía , Antimetabolitos Antineoplásicos/uso terapéutico , Terapia Combinada , Humanos , Imagen por Resonancia Magnética , Masculino , Metotrexato/uso terapéutico , Leucemia-Linfoma Linfoblástico de Células Precursoras B/diagnóstico por imagen , Leucemia-Linfoma Linfoblástico de Células Precursoras B/tratamiento farmacológico , Neoplasias de la Columna Vertebral/diagnóstico por imagen , Neoplasias de la Columna Vertebral/tratamiento farmacológico , Columna Vertebral/diagnóstico por imagen , Adulto JovenAsunto(s)
Neoplasias Cardíacas/patología , Trasplante de Células Madre Hematopoyéticas , Leucemia-Linfoma Linfoblástico de Células Precursoras B/cirugía , Adulto , Biopsia , Ecocardiografía , Resultado Fatal , Neoplasias Cardíacas/genética , Neoplasias Cardíacas/inmunología , Neoplasias Cardíacas/terapia , Humanos , Inmunohistoquímica , Imagen por Resonancia Magnética , Masculino , Leucemia-Linfoma Linfoblástico de Células Precursoras B/genética , Leucemia-Linfoma Linfoblástico de Células Precursoras B/inmunología , Leucemia-Linfoma Linfoblástico de Células Precursoras B/patología , Trasplante Homólogo , Resultado del TratamientoRESUMEN
Thyroid abscess is a very rare clinical condition. It usually occurs in immunocompromised individuals or those with underlying malignancy. We report a case of multiple thyroid abscesses in the patient with Pre B acute lymphoblastic leukaemia which developed secondary to hematogenous spread from pyomyositis of right calf muscle. The patient developed sepsis-associated disseminated intravascular coagulation, which got resolved after thyroidectomy. He became afebrile after surgical intervention. Unfortunately, all the cultures were negative. Since there are few case series and reports, there are no clear guidelines for management of thyroid abscess. We conclude that though rare, thyroid abscess may be the cause of persistent fever in immunocompromised patients.
Asunto(s)
Absceso/patología , Antibacterianos/uso terapéutico , Drenaje , Fiebre/terapia , Leucemia-Linfoma Linfoblástico de Células Precursoras B/patología , Piomiositis/diagnóstico , Sepsis/diagnóstico , Enfermedades de la Tiroides/patología , Glándula Tiroides/patología , Tiroidectomía , Adolescente , Protocolos de Quimioterapia Combinada Antineoplásica , Clindamicina/uso terapéutico , Fiebre/etiología , Fiebre/patología , Humanos , Masculino , Meropenem , Leucemia-Linfoma Linfoblástico de Células Precursoras B/complicaciones , Leucemia-Linfoma Linfoblástico de Células Precursoras B/cirugía , Prednisolona/uso terapéutico , Piomiositis/complicaciones , Piomiositis/tratamiento farmacológico , Sepsis/tratamiento farmacológico , Sepsis/etiología , Teicoplanina/uso terapéutico , Tienamicinas/uso terapéutico , Enfermedades de la Tiroides/etiología , Enfermedades de la Tiroides/cirugía , Resultado del TratamientoRESUMEN
We report the case of a 75-year-old man who presented for evaluation of painless hematuria persisting for more than 1 month. At the time of presentation, the patient did not report any systemic symptoms and had no fever, weight loss, or dysuria. Computed tomography showed several enhancing, sessile polyps in the gall bladder (1.5 cm or smaller). There was no associated stone or biliary dilation. Since no other abnormality was evident, we performed laparoscopic cholecystectomy. He was diagnosed as having B-cell lymphoblastic lymphoma (B-LBL) after surgical resection of the gall bladder (GB). As the left mandibular swelling was developed after the diagnosis of the B-LBL involving GB, facial magnetic resonance imaging (MRI) was added to the imaging scan. Facial MRI revealed mass formation in the left mandible, left medial pterygoid, masticator, and buccinator muscles. The biopsy samples from the mandibular bone were also diagnosed as B-LBL. The definitive pathological diagnosis was B-LBL, stage IV. Systemic chemotherapy was done with subsequent response in size of the left mandible mass.
Asunto(s)
Neoplasias Óseas/diagnóstico , Neoplasias Óseas/secundario , Neoplasias de la Vesícula Biliar/patología , Mandíbula/patología , Leucemia-Linfoma Linfoblástico de Células Precursoras B/patología , Anciano , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Médula Ósea/patología , Neoplasias Óseas/tratamiento farmacológico , Colecistectomía Laparoscópica , Neoplasias de la Vesícula Biliar/diagnóstico , Neoplasias de la Vesícula Biliar/cirugía , Humanos , Inmunohistoquímica , Imagen por Resonancia Magnética , Masculino , Leucemia-Linfoma Linfoblástico de Células Precursoras B/diagnóstico , Leucemia-Linfoma Linfoblástico de Células Precursoras B/cirugía , Resultado del Tratamiento , Espera VigilanteRESUMEN
Thromboembolism is a complication of hematopoietic stem cell transplant. However, a literature search showed no previous reports of cerebral infarction during the thrombocytopenic stage after hematopoietic stem cell transplant. A 35-year-old woman with acute lymphoblastic leukemia (precursor B-cell type) was treated with hematopoietic stem cell transplant after induction and consolidation chemotherapy. On day 2 after transplant, she was unconscious, and had urinary incontinence and left hemiplegia. A computed tomography scan of the brain showed an acute ischemic infarct in the right middle cerebral artery region and an old infarct at the left thalamus without atherosclerosis. Factor VIII level was elevated (190%; normal range, 60% to 150%). She was treated with rehabilitation and low-dose aspirin. At 6 months after transplant, the leukemia remained in remission and she had no further thromboembolic events. This case suggests that prudent treatment of patients who have hematopoietic stem cell transplant may include monitoring for thromboembolism and testing factor VIII level before transplant.
Asunto(s)
Factor VIII/metabolismo , Trasplante de Células Madre Hematopoyéticas/efectos adversos , Infarto de la Arteria Cerebral Media/etiología , Leucemia-Linfoma Linfoblástico de Células Precursoras B/cirugía , Trombocitopenia/etiología , Tromboembolia/etiología , Enfermedad Aguda , Adulto , Biomarcadores/sangre , Femenino , Humanos , Infarto de la Arteria Cerebral Media/sangre , Infarto de la Arteria Cerebral Media/diagnóstico , Infarto de la Arteria Cerebral Media/terapia , Factores de Riesgo , Trombocitopenia/sangre , Trombocitopenia/diagnóstico , Tromboembolia/sangre , Tromboembolia/diagnóstico , Tromboembolia/terapia , Factores de Tiempo , Regulación hacia ArribaRESUMEN
Rhino-orbito-cerebral mucormycosis is a rare fulminant opportunistic fungal infection that particularly occurs in immunocompromised patients. We present a case of fatal invasive rhino-orbito-cerebral mucormycosis complicated by bilateral thrombotic occlusion of the internal carotid artery with consequent cerebral infarction in a 5-year-old boy after hematopoietic stem cell transplantation for acute pre-B-cell lymphoblastic leukemia.
Asunto(s)
Encefalopatías/patología , Trombosis de las Arterias Carótidas/patología , Trasplante de Células Madre Hematopoyéticas/efectos adversos , Mucormicosis/patología , Infecciones Oportunistas/patología , Encefalopatías/microbiología , Preescolar , Resultado Fatal , Humanos , Masculino , Enfermedades Nasales/microbiología , Enfermedades Nasales/patología , Infecciones Oportunistas/microbiología , Enfermedades Orbitales/microbiología , Enfermedades Orbitales/patología , Leucemia-Linfoma Linfoblástico de Células Precursoras B/cirugíaRESUMEN
Despite improvements in treatment, the prognosis of relapsed or primary refractory acute lymphocytic leukemia (ALL) remains poor, and outcomes are worse in older adults with the short first complete remission (CR). Attainment of the second CR by salvage therapy would improve the survival of these patients and may enable them to undergo curative treatment with allogeneic hematopoietic stem cell transplantation. The fact that there are diverse salvage protocols for these adult patients but without a striking CR-induction efficacy indicates that efforts are still needed to indentify new effective reinduction regimens. In this study, the CAG regimen (cytarabine, 10 mg/m(2) subcutaneously every 12 h on days 1-14; aclarubicin, 5-7 mg/m(2) intravenously daily on days 1-8; and concurrent granulocyte colony-stimulating factor, 200 µg/m(2) /day subcutaneously) was administered to 25 patients with relapsed or refractory ALL, including 11 T-cell ALL (T-ALL) and 14 B-cell (B-ALL) patients (age range, 11-61 years; median age, 26 years), to assess its efficacy as a salvage therapy. One course of the CAG regimen resulted in an overall response [CR or partial remission (PR)] rate of 64%, a CR rate of 56% and generally mild adverse effects. An overall response was observed in all 11 T-ALL patients (10 CR and 1 PR) and 35.7% of B-ALL patients (p = 0.0009). The significant treatment potential of CAG regimen for relapsed or primary refractory ALL, especially for T-ALL patients, described in this report would prepare them for a second CR to pursue longer survival.
Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Leucemia-Linfoma Linfoblástico de Células Precursoras/tratamiento farmacológico , Terapia Recuperativa , Aclarubicina/administración & dosificación , Adolescente , Adulto , Protocolos de Quimioterapia Combinada Antineoplásica/administración & dosificación , Niño , China , Terapia Combinada , Citarabina/administración & dosificación , Supervivencia sin Enfermedad , Evaluación de Medicamentos , Resistencia a Antineoplásicos , Femenino , Factor Estimulante de Colonias de Granulocitos/administración & dosificación , Trasplante de Células Madre Hematopoyéticas , Humanos , Masculino , Persona de Mediana Edad , Leucemia-Linfoma Linfoblástico de Células Precursoras B/tratamiento farmacológico , Leucemia-Linfoma Linfoblástico de Células Precursoras B/cirugía , Leucemia-Linfoma Linfoblástico de Células Precursoras/cirugía , Recurrencia , Estudios Retrospectivos , Resultado del Tratamiento , Adulto JovenAsunto(s)
Paraplejía , Leucemia-Linfoma Linfoblástico de Células Precursoras B/diagnóstico , Complicaciones Neoplásicas del Embarazo/diagnóstico , Vértebras Torácicas , Adulto , Anticuerpos Monoclonales de Origen Murino/uso terapéutico , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Cesárea , Ciclofosfamida/uso terapéutico , Dexametasona/uso terapéutico , Doxorrubicina/uso terapéutico , Femenino , Humanos , Laminectomía , Imagen por Resonancia Magnética , Masculino , Leucemia-Linfoma Linfoblástico de Células Precursoras B/tratamiento farmacológico , Leucemia-Linfoma Linfoblástico de Células Precursoras B/cirugía , Prednisona/uso terapéutico , Embarazo , Complicaciones Neoplásicas del Embarazo/tratamiento farmacológico , Complicaciones Neoplásicas del Embarazo/cirugía , Rituximab , Vincristina/uso terapéuticoRESUMEN
Necrotizing fasciitis is a potentially life-threatening infection of deep skin layers and subcutaneous tissues that can easily spread across the fascia plate and is usually the result of a combined infection with anaerobic and aerobic microorganisms. The patient typically complains of excruciating pain, which is not necessarily in accordance with clinical signs. Early recognition of the condition is very important, and aggressive treatment with a combination of antibiotics and surgical procedure is crucial. We present a case of a 15-year-old girl with acute lymphoblastic leukemia who developed necrotizing fasciitis after venous access port implantation during induction chemotherapy.
Asunto(s)
Cateterismo Venoso Central/efectos adversos , Catéteres de Permanencia/efectos adversos , Fascitis Necrotizante/etiología , Complicaciones Posoperatorias , Leucemia-Linfoma Linfoblástico de Células Precursoras B/complicaciones , Infecciones por Serratia/etiología , Serratia marcescens , Adolescente , Femenino , Humanos , Leucemia-Linfoma Linfoblástico de Células Precursoras B/cirugía , PronósticoAsunto(s)
Neoplasias Gastrointestinales/patología , Tumores del Estroma Gastrointestinal/patología , Trasplante de Células Madre Hematopoyéticas , Leucemia-Linfoma Linfoblástico de Células Precursoras B/patología , Leucemia-Linfoma Linfoblástico de Células Precursoras B/cirugía , Adulto , Neoplasias Gastrointestinales/cirugía , Tumores del Estroma Gastrointestinal/cirugía , Humanos , MasculinoRESUMEN
A 20-year-old woman presented with multiple painless nodular swellings on the skin of the extremities and face, without any systemic symptoms. Biopsy with immunohistochemistry revealed a diagnosis of precursor B-cell lymphoblastic lymphoma. There was no extracutaneous site of involvement. The patient denied chemotherapy and was subsequently lost to follow-up. She presented with symptomatic disseminated disease 18 months later and rapidly succumbed to her illness.
Asunto(s)
Leucemia-Linfoma Linfoblástico de Células Precursoras B/diagnóstico , Leucemia-Linfoma Linfoblástico de Células Precursoras B/cirugía , Leucemia-Linfoma Linfoblástico de Células Precursoras/diagnóstico , Leucemia-Linfoma Linfoblástico de Células Precursoras/cirugía , Adulto , Biopsia/métodos , Cromatina/metabolismo , Resultado Fatal , Femenino , Humanos , Inmunohistoquímica/métodos , Mitosis , Piel/patología , Neoplasias Cutáneas/patologíaRESUMEN
26 year-old male patient with diagnosis of acute lymphoblastic leukemia in 2006, who underwent chemotherapy and suffered a relapse and pulmonary aspergillosis as a complication. In 2009, he received bone marrow transplant. After it, he developed cutaneous and intestinal graft versus host disease (GVH). He was admitted for diarrhea. Then he presented grade IV dyspnea, patchy alveolar infiltrates on chest computed tomography and pancytopenia with impaired renal function as laboratory findings. He entered Intensive Care Unit, dying 7 days later. The oncologist who discussed the case defined this patient as a high risk case because of type of transplant received, relapse and complications. His diagnostic hypotheses were: CMV infection, pulmonary aspergillosis reactivation, chronic GVH, Pneumocystis jiroveci infection, mycobacteriosis and pseudomembranous colitis. Partial autopsy revealed diffuse intra-alveolar hemorrhage, diffuse alveolar damage, right pulmonary infarction with microthrombosis and bronchiolitis obliterans organizing pneumonia.
Asunto(s)
Trasplante de Médula Ósea/efectos adversos , Leucemia-Linfoma Linfoblástico de Células Precursoras B/cirugía , Adulto , Autopsia , Resultado Fatal , Humanos , Masculino , Leucemia-Linfoma Linfoblástico de Células Precursoras B/patologíaRESUMEN
Sclerodermatous chronic graft-versus-host disease (cGVHD) following allogeneic hematopoietic stem cell transplantation (HSCT) in children is difficult to treat and life-threatening. Extracorporeal photochemotherapy (ECP; photopheresis), an immunomodulatory therapy that involves the infusion of autologous peripheral blood leukocytes after ex vivo exposure to the photoactive agent 8-methoxypsoralen and ultraviolet A radiation, is an effective treatment for steroid-refractory cGVHD. After undergoing allogeneic HSCT for pre-B-cell acute lymphoblastic leukemia, a 14-year-old boy developed extensive sclerodermatous cGVHD that was refractory to prednisone, tacrolimus, and sirolimus. ECP was administered over the course of 53 months, during which the skin softened substantially and immunosuppressive therapy was discontinued. This case suggests that long-term ECP is a viable option in children with sclerodermatous cGVHD.
Asunto(s)
Enfermedad Injerto contra Huésped/tratamiento farmacológico , Trasplante de Células Madre Hematopoyéticas/efectos adversos , Fotoféresis/métodos , Esclerodermia Sistémica/tratamiento farmacológico , Adolescente , Enfermedad Crónica , Humanos , Masculino , Leucemia-Linfoma Linfoblástico de Células Precursoras B/cirugía , Prednisona/uso terapéutico , Trasplante Homólogo , Resultado del TratamientoRESUMEN
INTRODUCTION: Primary lymphomas of the female genital tract are rare. Most involve the cervix rather than the uterine corpus. Many cases of primary endometrial lymphoma are diagnosed as diffuse large B cell type, whereas the precursor B cell lymphoblastic type is extremely rare. MATERIALS AND METHODS: We report a case of precursor B cell lymphoblastic lymphoma of uterine corpus which was successfully treated with surgery and chemotherapy. Staging evaluation revealed tumor limited to the uterine corpus (stage I(E)). After receiving a total abdominal hysterectomy, bilateral salpingooophorectomy, lymph node dissection and combination chemotherapy, the patient is currently free of disease after follow-up of 42 months. CONCLUSION: If correct diagnosis is established and appropriate therapy is chosen, the prognosis of precursor B-LBL of uterine corpus is expected to be good. The literature on primary precursor B cell lymphoblastic lymphoma of the uterine corpus is reviewed.
Asunto(s)
Leucemia-Linfoma Linfoblástico de Células Precursoras B/terapia , Neoplasias Uterinas/terapia , Adulto , Antineoplásicos/uso terapéutico , Protocolos de Quimioterapia Combinada Antineoplásica , Terapia Combinada , Femenino , Humanos , Histerectomía/métodos , Escisión del Ganglio Linfático , Ovariectomía/métodos , Leucemia-Linfoma Linfoblástico de Células Precursoras B/tratamiento farmacológico , Leucemia-Linfoma Linfoblástico de Células Precursoras B/patología , Leucemia-Linfoma Linfoblástico de Células Precursoras B/cirugía , Neoplasias Uterinas/tratamiento farmacológico , Neoplasias Uterinas/patología , Neoplasias Uterinas/cirugíaAsunto(s)
Neoplasias de Cabeza y Cuello/patología , Leucemia-Linfoma Linfoblástico de Células Precursoras B/patología , Cuero Cabelludo/patología , Neoplasias Cutáneas/patología , Anciano , Diagnóstico Diferencial , Femenino , Estudios de Seguimiento , Neoplasias de Cabeza y Cuello/cirugía , Humanos , Leucemia-Linfoma Linfoblástico de Células Precursoras B/cirugía , Cuero Cabelludo/cirugía , Neoplasias Cutáneas/cirugíaAsunto(s)
Nucleótidos de Adenina/administración & dosificación , Arabinonucleósidos/administración & dosificación , Leucemia-Linfoma Linfoblástico de Células Precursoras B/tratamiento farmacológico , Inmunología del Trasplante/efectos de los fármacos , Clofarabina , Femenino , Enfermedad Injerto contra Huésped , Efecto Injerto vs Leucemia/efectos de los fármacos , Trasplante de Células Madre Hematopoyéticas , Humanos , Persona de Mediana Edad , Leucemia-Linfoma Linfoblástico de Células Precursoras B/inmunología , Leucemia-Linfoma Linfoblástico de Células Precursoras B/cirugíaAsunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Leucemia-Linfoma Linfoblástico de Células Precursoras B/tratamiento farmacológico , Terapia Recuperativa , Nucleótidos de Adenina/administración & dosificación , Aminoglicósidos/administración & dosificación , Anticuerpos Monoclonales/administración & dosificación , Anticuerpos Monoclonales Humanizados , Antígenos CD/análisis , Antígenos de Diferenciación Mielomonocítica/análisis , Protocolos de Quimioterapia Combinada Antineoplásica/administración & dosificación , Arabinonucleósidos/administración & dosificación , Asparaginasa/administración & dosificación , Médula Ósea/patología , Trasplante de Médula Ósea , Clofarabina , Terapia Combinada , Citarabina/administración & dosificación , Daunorrubicina/administración & dosificación , Gemtuzumab , Humanos , Masculino , Leucemia-Linfoma Linfoblástico de Células Precursoras B/inmunología , Leucemia-Linfoma Linfoblástico de Células Precursoras B/cirugía , Prednisona/administración & dosificación , Inducción de Remisión , Lectina 3 Similar a Ig de Unión al Ácido Siálico , Trasplante Homólogo , Resultado del Tratamiento , Vincristina/administración & dosificación , Adulto JovenRESUMEN
BACKGROUND: Acute lymphoblastic leukemia is a malignant disease of the bone marrow in which early lymphoid precursors proliferate and replace normal marrow hematopoietic cells, resulting in a marked decrease in the production of normal blood cells. CASE REPORT: We report a case of isolated ovarian relapse 7 years after the primary diagnosis in a patient, who was seemingly in clinical remission following unilateral ovariectomy and second-line chemotherapy. CONCLUSION: In contrast to testicular relapse, ovarian relapses in acute lymphoblastic leukemia are rarely reported. Surgical removal of the mass followed by chemotherapy is the therapeutic standard.