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Sedeta E, Pokhrel A, Nair K, Gotlieb V. Intraoral myeloid sarcoma presenting as toothache and gingival mass. BMJ Case Rep 2022; 15:15/12/e251452. [PMID: 36593620 PMCID: PMC9743265 DOI: 10.1136/bcr-2022-251452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
A female patient in her 70s with a medical history of myelodysplastic neoplasm presented to the outpatient department with a 4-month history of toothache, painful gingival swelling and loose teeth that required extractions. Intraoral examination revealed a swelling in the lower anterior portion of the mandible, which displaced her teeth. Incisional biopsy of the gingival lesion revealed dense aggregates of atypical round cells which stained positive for CD43, CD45, CD33 and myeloperoxidase, consistent with myeloid sarcoma. Subsequent bone marrow biopsy displayed hypercellular marrow with immature myeloid elements and 21% myeloblasts by flow cytometry, compatible with diagnosis of acute myeloid leukaemia (AML). The patient initially went into remission after treatment but later died of AML relapse after 18 months.
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Affiliation(s)
- Ephrem Sedeta
- Medicine, Brookdale University Hospital and Medical Center, Brooklyn, New York, USA
| | - Akriti Pokhrel
- Medicine, Brookdale University Hospital and Medical Center, Brooklyn, New York, USA
| | - Kiron Nair
- Division of Hematology and Medical Oncology, Brookdale University Hospital and Medical Center, Brooklyn, New York, USA
| | - Vladimir Gotlieb
- Division of Hematology and Medical Oncology, Brookdale University Hospital and Medical Center, Brooklyn, New York, USA
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Levanon S, Gotlieb V, Kraus Y, Novofastovski I, Brikman S, Fawaz A, Aghbariyya M, Butbul Y, Balbir-Gurman A, Mader R, Bieber A. POS0831 IgA VASCULITIS IN ADULTS, PEDIATRICS AND NON-VASCULITIC IgA NEPHROPATHY. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.3368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundIgA vasculitis (IgAV) has been extensively studied in children, while its natural history remains poorly studied in adults. Sparse data comparing childhood and adult-onset disease has shown significant differences in their clinical presentation, especially in the severity of renal involvement, which accounts for the major long-term morbidity. IgAV shares similar renal histologic features with IgA nephropathy (IgAN), while clinically IgAN is a chronic kidney disease which may lead to end stage renal disease and dialysis. The extent of kidney injury among adults with IgAV is still a matter of uncertainty.ObjectivesWe aimed to evaluate clinical manifestations, laboratory data, treatment patterns and long-term outcomes of pediatric and adult-onset IgAV in comparison to IgAN.MethodsThis retrospective collaborative study examined medical records of adults and children with IgAV and IgAN adult patients admitted to rheumatology clinic and in hospital pediatric departments in a 13-year period (2007-2019). Diagnosis of adults with IgAV relied on the Ankara criteria and was confirmed by a consistent skin biopsy with positive IgA staining by immunofluorescence. Children with IgAV were included in our study on a clinical basis. All IgAN patients had a kidney biopsy proven disease. We analyzed and compared frequencies of clinical manifestations, laboratory findings, treatment regimens and long-term outcomes at one year follow-up. Finally, we assessed long term outcomes, such as time to dialysis and all-cause mortality, till the end of the follow-up time.ResultsA total of 60 adult IgAV, 60 pediatric IgAV and 45 IgAN patients were included in our study. There were significantly more males in the IgAN group compared to the adult and pediatric IgAV groups (77.8%, 41.7% and 55% respectively, p=0.01). Adult IgAV patients were significantly older than IgAN patients (53.1±17.4 years vs. 45.1±15.7 years, p=0.02) and had significantly higher rates of diabetes (43.3% vs. 24.4%, p=0.05) and ischemic heart disease (18.3% vs. 4.4%, p=0.03). The pediatric IgAV group had a statistically higher rate of previous infection compared to the adult IgAV group (44.8% vs. 20%, p=0.02). At one year follow-up, IgAN patients had higher levels of serum creatinine compared to the adult IgAV group (2.002 vs. 1.100, p<0.01). Data observed until the end of the follow-up time showed no difference in time to dialysis (IgAV adults: 9.8-12.4 years, IgAN: 5.0-6.6 years, p>.41). Nevertheless, IgAV adult patients had significantly shorter survival time (5.5 years, 95% CI: 4.8-6.2 years) than IgAN patients (7.0 years, 95% CI: 6.6-7.5 years, p<.01).ConclusionThis retrospective study demonstrates that IgAV in adults presents substantial clinical manifestations, including high risk of progression to persistent renal impairment and possesses higher mortality rate in comparison with pediatric-onset disease and IgAN.References[1]Blanco R, Martínez-Taboada VM, Rodríguez-Valverde V, García-Fuentes M, González-Gay MA. Henoch-Schönlein purpura in adulthood and childhood: two different expressions of the same syndrome. Arthritis Rheum. 1997 May;40(5):859-64. doi: 10.1002/art.1780400513. PMID: 9153547.[2]Nossent J, Raymond W, Isobel Keen H, Preen D, Inderjeeth C. Morbidity and mortality in adult-onset IgA vasculitis: a long-term population-based cohort study. Rheumatology (Oxford). 2021 Dec 24;61(1):291-298. doi: 10.1093/rheumatology/keab312. PMID: 33779729.Figure 1.Disclosure of InterestsNone declared
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Yadav R, Ilerhunmwuwa NP, Uwagbale E, Omaliko C, Aliahmad A, Sedeta E, Ozdemir D, Pokhrel A, Alexander E, Udaikumar J, Heravi O, Hakobyan N, Aroshidze B, Shi J, Jazi FS, Nemakallu S, Gotlieb V, Chkhikvadze T. Outcomes of bile duct resection with or without liver resection in management of Klatskin tumor: A 15-year U.S. National Data Review. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.e16169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e16169 Background: Surgical resection can provide an increase in survival for incurable patients with cholangiocarcinoma (CCA); Since outcomes improve significantly with more aggressive intervention liver resection (LR) should be pursued together with common bile duct resection (CBDR). We aimed to analyze the trends of surgical management of hilar CCA also known as Klatskin tumor (KT) across 15 years in the U.S. Methods: We extracted two cohorts of hospitalizations from Nationwide Inpatient Sample (NIS) 2005-2019yy using ICD-9 and ICD-10 diagnosis and procedure codes for KT, CBDR and LR. First group of patients with KT had CBDR performed alone and the second group of KT patients received CBDR and LR during the same hospitalization. We compared mortality, performed socio-demographic analysis stratified by patient and hospital information and used length of stay (LOS) and mean charges (MC) as additional outcomes. Results: We extracted a total of 3,095 hospitalizations with KT that underwent CBDR alone or CBDR with LR. There was a transition in proportion of CBDR alone versus CBDR with LR across years, which we attribute to the change in coding from ICD-9 to ICD- 10, with the combined coding year 2015 demonstrating equalization of proportion of performed procedures prior to the flip in 2016. Since ICD-10 procedure coding was more specific for CBDR and LR, we as a result of this conclude that ICD-10 coding years 2016 and onward are more accurate and the latest trends demonstrate the increasing performance of only CBDR in KT patients rather than CBDR with LR (75% vs. 25% in 2019). Analysis of socio-demographics is presented in the Table. More than 2/3 of the patients were above age 60. Proportionally CBDR alone was more likely to be covered by public insurance than CBDR with LR (Public: 63.7% vs. 57.1%; Private: 34% vs. 40%). Even though it is a more invasive intervention, CBDR with LR had slightly less mean overall charges (MC=$223,903 for CBDR vs. $212,072 for CBDR with LR (P=0.5574)) and similar hospital resource utilization (LOS= 14 days for CBDR vs.14.7 days for CBDR with LR) compared to CBDR alone. Most of the procedures (>94%) were performed in teaching hospitals. Inpatient mortality was 5.5% for CBDR alone vs. 8.7 % for CBDR with LR. Conclusions: Our analysis demonstrated that for KT proportionally, CBDR performance is more prevalent than CBDR with LR in the latest years 2016-2019. Considering the comparable cost and hospital resource utilization with intent to cure, more aggressive surgical management should be pursued. Inpatient mortality was higher for more aggressive surgical management 5.5% for CBDR alone vs. 8.7% for CBDR with LR. Insurance type may play a role in the procedure choice. [Table: see text]
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Affiliation(s)
- Ruchi Yadav
- One Brooklyn health Brookdale University Hospital, Brooklyn, NY
| | | | - Ese Uwagbale
- One Brooklyn Health Brookdale University Hospital, Brooklyn, NY
| | - Chidiebele Omaliko
- One Brooklyn Health Brookdale University Hospital, Department of Medicine, Brooklyn, NY
| | - Aftaab Aliahmad
- One Brooklyn Health System Brookdale University Hospital, Brooklyn, NY
| | - Ephrem Sedeta
- One Brooklyn Health Brookdale University Hospital, Department of Medicine, Brooklyn, NY
| | - Derman Ozdemir
- One Brooklyn Health Brookdale University Hospital, Department of Medicine, Brooklyn, NY
| | - Akriti Pokhrel
- One Brooklyn Health Brookdale University Hospital, Department of Medicine, Brooklyn, NY
| | - Elmarie Alexander
- One Brooklyn Health Brookdale University Hospital, Department of Medicine, Brooklyn, NY
| | | | - Omid Heravi
- One Brooklyn Health Brookdale University Hospital, Department of Medicine, Brooklyn, NY
| | | | - Beka Aroshidze
- One Brooklyn Health Brookdale University Hospital, Department of Medicine, Brooklyn, NY
| | - Junxin Shi
- The Research Institute at Nationwide Children's Hospital, Columbus, OH
| | | | - Sharanya Nemakallu
- One Brooklyn Health Brookdale University Hospital, Department of Medicine, Brooklyn, NY
| | - Vladimir Gotlieb
- One Brooklyn Health Brookdale University Hospital, Department of Hematology and Oncology, Brooklyn, NY
| | - Tamta Chkhikvadze
- One Brooklyn Health System Brookdale University Hospital, Brooklyn, NY
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Yadav R, Sun L, Salyana M, Eric M, Gotlieb V, Wang JC. SMARCA4-Deficient Undifferentiated Tumor of Lung Mass—A Rare Tumor With the Rarer Occurrence of Brain Metastasis: A Case Report and Review of the Literature. J Investig Med High Impact Case Rep 2022; 10:23247096221074864. [PMID: 35356840 PMCID: PMC8978313 DOI: 10.1177/23247096221074864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Among thoracic tumors, these include subsets of a relatively newly described and yet to be fully characterized tumor entity: SMARCA4-deficient Undifferentiated Tumor (SMARCA4-dUT). Mutations of SMARCA4 (SWI/SNF-related, matrix-associated, actin-dependent regulator of chromatin, subfamily A, member 4) gene and loss of BRG1 (Brahma-related gene-1) is the underlying molecular hallmark of SMARCA4-dUT. They mostly involved the mediastinum, lung, and/or pleura showing undifferentiated round cell or rhabdoid morphology associated with aggressive clinical behavior. The pathogenesis of these tumors is still not clear. Morphologically, SMARAC4-dUT is differentiated from SMARCA4-dNSCLC by the presence of squamous and solid components in the latter. Immunohistochemically SMARC4-dUT has characteristic loss of SMARCA4 and SMARCA2 and strong expression of SOX2, CD34, and SALL4. Common sites of metastasis include lymph nodes, bones, and adrenal glands but rarely brain metastasis. We present a unique and rare case of a 76-year-old male with a right lung mass with documented pathology of SMARCA4-dUT and was found to have multiple brain metastases.
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Affiliation(s)
- Ruchi Yadav
- Brookdale University Hospital Medical Center, Brooklyn, NY, USA
| | - Lishi Sun
- Brookdale University Hospital Medical Center, Brooklyn, NY, USA
| | | | - Minkin Eric
- Brookdale University Hospital Medical Center, Brooklyn, NY, USA
| | | | - Jen C. Wang
- Brookdale University Hospital Medical Center, Brooklyn, NY, USA
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Aroshidze B, Boyapati L, Pokhrel A, Gotlieb V, Khan A, Erdinc B, Cheema MA. Yolk Sac Tumor in the Anterior Mediastinum Presenting as Acute Pericarditis. Am J Case Rep 2022; 23:e932616. [PMID: 35077441 PMCID: PMC8800463 DOI: 10.12659/ajcr.932616] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Mediastinal masses can originate from anatomical structures normally located in the mediastinum, or from structures that travel through the mediastinum during embryogenesis. Initial presenting symptoms usually vary from shortness of breath, cough, chest pain, and superior vena cava syndrome to nonspecific constitutional symptoms (eg, fever, weight loss, fatigue). However, the initial presentation of a mediastinal mass with acute pericarditis has not been reported in the literature as far as we know. CASE REPORT A 20-year-old man presented to the Cardiology Clinic with chest pain and new pericardial effusion on echocardiography, both fulfilling the diagnostic criteria of acute pericarditis. The patient also had venous engorgement on the neck, and a chest X-ray followed by computed tomography imaging showed a large mediastinal mass. The serum tumor marker a-fetoprotein (AFP) was markedly elevated. The biopsy and immunohistochemistry revealed a high-grade malignant neoplasm - yolk sac tumor, which is a type of non-seminomatous germ cell tumor. The acute pericarditis resolved after administration of NSAID and colchicine. The patient was then started on chemotherapy. CONCLUSIONS The discussed case shows the rare presentation of an anterior mediastinal mass with acute pericarditis. This emphasizes the importance of a thorough review of systems and critical analysis of every sign and symptom at the time of initial presentation, which helps the physician to obtain appropriate imaging studies early in the course, leading to an early diagnosis and treatment of the disease, such as in this case of an extremely rare germ cell tumor.
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Affiliation(s)
- Beka Aroshidze
- Department of Internal Medicine, One Brooklyn Health System, Brooklyn, NY, USA
| | - Lakshmi Boyapati
- Department of Hematology and Oncology, One Brooklyn Health System, Brooklyn, NY, USA
| | - Akriti Pokhrel
- Department of Internal Medicine, One Brooklyn Health System, Brooklyn, NY, USA
| | - Vladimir Gotlieb
- Department of Hematology and Oncology, One Brooklyn Health System, Brooklyn, NY, USA
| | - Abdullah Khan
- Department of Cardiology, One Brooklyn Health System, Brooklyn, NY, USA
| | - Burak Erdinc
- Department of Hematology and Oncology, One Brooklyn Health System, Brooklyn, NY, USA
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Yadav R, Aroshidze B, Yadav V, Zahid U, Jayarangaiah A, Gandhi A, Gotlieb V. Observational Study of Thrombotic Events in a Random Cohort of Hospitalized COVID-19 Patients at a Community-Based Hospital of New York City During the Beginning of the 2020 Pandemic. Cureus 2021; 13:e18601. [PMID: 34765362 PMCID: PMC8572526 DOI: 10.7759/cureus.18601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/08/2021] [Indexed: 12/15/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19) continues to pose an unprecedented challenge for the entire world and the healthcare system. Different theories have been proposed elucidating the pathophysiological mechanisms attributing to high mortality and morbidity in COVID-19 infection. Out of them, thrombosis and procoagulant state have managed to earn the maximum limelight. We conducted an observational study based on data from randomly selected 349 hospitalized patients with COVID-19 infection in a community-based hospital in New York City during the first wave of the COVID-19 viral surge in March 2020. The main objective of our study was to assess the risk and occurrence of thrombotic events (both venous and arterial) among the hospitalized patients including the intensive care unit (ICU) and non-ICU admissions with confirmed COVID-19 infection. The primary outcome in our study was defined as the thrombotic events that included myocardial infarction (MI), deep venous thrombosis (DVT), cerebrovascular accidents (CVA), and pulmonary embolism (PE). The study correlated the association of thrombotic events with the level of biomarkers of interest: D-dimer >1000 ng/ml, troponin-I >1 ng/ml, or both. The association of D-dimers and troponin-I with thrombotic events was measured using both univariate and multivariate Cox proportional hazard (PH) regression analysis. Out of a total of 349 patients, 78 patients (22.35%) were found to have elevated biomarkers (D-dimer >1000 ng/ml and/or troponin-I >1 ng/ml) and were categorized as a high-risk group. Eighty-nine patients developed thrombotic complications (evidence of more than one thrombotic event was found in several patients). Two-hundred seventy-one (77.65%) patients had no documentation of thrombosis. The incidence of thrombotic events included myocardial infarction (MI; N=45; 12.8%), cerebrovascular accidents (CVA; N=16; 4.5%), deep venous thrombosis (DVT; N=16; 4.5%), and pulmonary embolism (PE; N=9; 2.57%).
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Affiliation(s)
- Ruchi Yadav
- Internal Medicine, Brookdale University Hospital and Medical Center, Brooklyn, USA
| | - Beka Aroshidze
- Internal Medicine, Brookdale University Hospital and Medical Center, Brooklyn, USA
| | - Vivek Yadav
- Pulmonary and Critical Care, State University of New York Downstate Health Sciences University, New York, USA
| | - Umar Zahid
- Nephrology, Brookdale University Hospital and Medical Center, Brooklyn, USA
| | - Apoorva Jayarangaiah
- Internal Medicine, New York City (NYC) Health and Hospitals/Jacobi Medical Center, Bronx, USA
| | - Anjula Gandhi
- Internal Medicine, Brookdale University Hospital and Medical Center, Brooklyn, USA
| | - Vladimir Gotlieb
- Hematology/Oncology, Brookdale University Hospital and Medical Center, Brooklyn, USA
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Ramachandran P, Erdinc B, Abowali HA, Zahid U, Gotlieb V, Spitalewitz S. High Incidence of Thrombotic Thrombocytopenic Purpura Exacerbation Rate Among Patients With Morbid Obesity and Drug Abuse. Cureus 2021; 13:e14656. [PMID: 34055510 PMCID: PMC8144271 DOI: 10.7759/cureus.14656] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/24/2021] [Indexed: 11/05/2022] Open
Abstract
This study aims to identify the baseline patient characteristics, clinical presentation, and response to treatment of 11 patients who were diagnosed with thrombotic thrombocytopenic purpura (TTP) between 2014 and 2020 at Brookdale University Hospital Medical Center, Brooklyn, NY. Laboratory and clinical parameters were recorded for 29 patients who received plasmapheresis in this time period. Of 29 patients, 11 had confirmed TTP and one was diagnosed with hereditary TTP. Young, black, and female patients made up the majority of our patient population. A high prevalence of obesity and drug abuse were seen among our patients. Five out of 11 were obese and four of them were morbidly obese; six out of 11 patients were positive for the drug screen including cannabinoids (3), opiates (2), benzodiazepines (1), PCP (1), and methadone (1). Four patients with a positive drug screen had acute kidney injury (AKI), and plasmapheresis helped them enhance their kidney function. We observed a high incidence of AKI and high TTP exacerbation rates in patients who were drug abusers and those who were morbidly obese. There is a paucity of data on the relationship of TTP with obesityor drug abuse and this needs further study.
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Affiliation(s)
- Preethi Ramachandran
- Hematology and Oncology, Brookdale University Hospital Medical Center, Brooklyn, USA
| | - Burak Erdinc
- Internal Medicine, Brookdale University Hospital Medical Center, Brooklyn, USA
| | - Hesham Ali Abowali
- Internal Medicine, Brookdale University Hospital Medical Center, Brooklyn, USA
| | - Umar Zahid
- Nephrology, Brookdale University Hospital Medical Center, Brooklyn, USA
| | - Vladimir Gotlieb
- Hematology and Oncology, Brookdale University Hospital Medical Center, Brooklyn, USA
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Abstract
The virus SARS-CoV-2 commonly causes self-resolving, flu-like illnesses in the majority of patients, but a critical illness can be seen in 5% of cases - especially in the elderly population or in patients with multiple comorbidities. When COVID-19 is severe, it can cause pneumonia and hypoxemic respiratory failure, and can progress to viremia involving multiple organ systems. It causes significant cytopenia, mainly severe lymphopenia, and excessive exhaustion of CD8+ T cells, resulting in an immunocompromised state and cytokine storm. Furthermore, COVID-19 can commonly be complicated with acute thrombotic events, including venous thromboembolism, acute stroke, acute myocardial infarction, clotting of hemodialysis and extracorporeal membrane oxygenation (ECMO) catheters, and acute limb ischemia. This makes SARS-COV-2 a unique virus with an undiscovered pathophysiology. Therefore, patients with COVID-19 need close monitoring of their symptoms and laboratory parameters, and early hospitalization and treatment in severe cases. Early identification of severe cases and the abovementioned complications of COVID-19 could decrease the morbidity and mortality caused by the disease. In the study, we summarize what is currently known about the hematological manifestations and complications of COVID-19.
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Affiliation(s)
- Burak Erdinc
- Department of Internal Medicine, Brookdale University Hospital and Medical Center, New York, USA
| | - Sonu Sahni
- Department of Internal Medicine, Brookdale University Hospital and Medical Center, New York, USA
| | - Vladimir Gotlieb
- Department of Hematology and Oncology, Brookdale University Hospital and Medical Center, New York, USA
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Andreev A, Erdinc B, Shivaraj K, Schmutz J, Levochkina O, Bhowmik D, Farag F, Money KM, Primavera LH, Gotlieb V, Sahni S. The Association Between Anemia of Chronic Inflammation and Alzheimer's Disease and Related Dementias. J Alzheimers Dis Rep 2020; 4:379-391. [PMID: 33163899 PMCID: PMC7592836 DOI: 10.3233/adr-200178] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Background Dementia is a spectrum of neurological diseases characterized by memory impairment and cognitive decline with the pathogenesis and effective management remaining elusive. Several studies have identified a correlation between anemia and Alzheimer's disease and related dementias (ADRD); however, anemia subtypes and association with ADRD have yet to be studied conclusively. Objective To study an association between ADRD and anemia of chronic inflammation. Methods We conducted a retrospective case-control study of the patients, diagnosed with ADRD at Brookdale Hospital. Pair-wise comparisons between means of controls and cases in terms of iron studies and laboratory results were performed using a Mann-Whitney U test. Pair-wise comparisons between anemia subgroups (moderate and severe) were performed using a Two Sample proportion Z-Test, where for each couple of normally distributed population. Results There was a total of 4,517 (1,274 ADRD group; 3,243 Control group) patients. There was significant difference in hemoglobin 10.15 versus 11.04 [p-value <0.001]. Iron studies showed a significant difference in ferritin 395±488.18 versus 263±1023.4 [p < 0.001], total iron binding capacity 225±84.08 versus 266±82.30 [p < 0.001] and serum iron level 64±39.34 versus 53±41.83 [p < 0.001]. Folic acid and vitamin B12 levels were normal in both groups. Severe and moderate anemia in the ADRD group were respectively 6.2% [95% CI: 4.2-8.4] and 13% [95% CI: 9.8-16.2] higher. Overall, incidence of moderate-to-severe anemia was found to be 19% higher in ADRD group [95% CI: 15.8-22.1]. Conclusion We demonstrated an association between ADRD and anemia of chronic inflammation independent of age, renal function, and HgbA1C levels.
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Affiliation(s)
- Alexander Andreev
- Brookdale University Hospital Medical Center, Department of Internal Medicine, Brooklyn, NY, USA.,Beth Israel Deaconess Medical Center, Department of Neurology, Boston, MA, USA
| | - Burak Erdinc
- Brookdale University Hospital Medical Center, Department of Internal Medicine, Brooklyn, NY, USA
| | - Kiran Shivaraj
- Brookdale University Hospital Medical Center, Department of Internal Medicine, Brooklyn, NY, USA
| | - Julia Schmutz
- Ross University School of Medicine, Miramar, FL, USA
| | - Olga Levochkina
- Richmond University Medical Center, Department of Psychiatry, Staten Island, NY, USA
| | - Dhrity Bhowmik
- Brookdale University Hospital Medical Center, Department of Internal Medicine, Brooklyn, NY, USA
| | - Fady Farag
- Brookdale University Hospital Medical Center, Department of Internal Medicine, Brooklyn, NY, USA
| | - Kelli M Money
- Beth Israel Deaconess Medical Center, Department of Neurology, Boston, MA, USA
| | | | - Vladimir Gotlieb
- Brookdale University Hospital Medical Center, Department of Internal Medicine, Division of Hematology & Oncology, Brooklyn, NY, USA
| | - Sonu Sahni
- Brookdale University Hospital Medical Center, Department of Internal Medicine, Brooklyn, NY, USA.,Department of Primary Care, Touro College of Osteopathic Medicine, New York, NY, USA.,Department of Research Medicine, NYIT College of Osteopathic Medicine, Glen Head, NY, USA
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Ramachandran P, Erdinc B, Gotlieb V. An Unusual Presentation of Merkel Cell Carcinoma in a HIV Patient: A Case Report and Literature Review. J Investig Med High Impact Case Rep 2020; 7:2324709619836695. [PMID: 30938171 PMCID: PMC6446430 DOI: 10.1177/2324709619836695] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Merkel cell carcinoma (MCC) is a rare, rapidly growing, aggressive neuroendocrine skin cancer that generally arises on sun-exposed areas of body such as head, neck, upper limbs, and shoulders of people with light complexity. Typically, MCC presents as shiny, flesh-colored or bluish-red, intracutaneous nodule, possibly with ulceration or crusting. In most of the cases, there is an association with Merkel cell polyomavirus. Even though these are very aggressive tumors, early detection and treatment has always given favorable outcome. There seems to be no consensus in definite prognostic markers, and advanced stages have the worst outcome even with treatment. There has been a recent trend in using PD-I/PD-L1 target therapy rather than chemotherapy in these cancers and have shown to improve survival by many months. In this article, we report a very unusual presentation of MCC first found on left frontoparietal skull as an 8-cm diameter fixed, subcutaneous mass without any typical features of MCC and was found to have metastatic spread to lung and liver. The patient was treated with palliative radiotherapy to brain and chemotherapy with cisplatin/etoposide with addition of immunotherapy later.
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Affiliation(s)
| | - Burak Erdinc
- 1 Brookdale University Hospitals and Medical Center, New York, NY, USA
| | - Vladimir Gotlieb
- 1 Brookdale University Hospitals and Medical Center, New York, NY, USA
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Wang JC, Shi G, Wong C, Gotlieb V, Ramachandran P, Chen H. Quantification of IGF-1 receptor is useful in the differential diagnosis of essential thrombocytosis from reactive thrombocytosis. Eur J Haematol 2019; 103:573-577. [PMID: 31479555 DOI: 10.1111/ejh.13323] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 08/29/2019] [Accepted: 08/30/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND To make a definite diagnosis of essential thrombocytosis (ET) from reactive thrombocytosis (RT), the most reliable criteria are the presence of driver mutations, namely JAK2, CALR, or MPL gene mutations. In the absence of these driver mutations, so-called triple-negative ET, the differential diagnosis could be difficult. Although bone marrow biopsy could be helpful, it may be difficult in some cases, to do gene sequence analysis to identify other clonal marker gene mutations than the driver mutations, as only very few were found. METHODS IGF-1R quantification by flow cytometry in mononuclear cells (MNC) from peripheral blood was performed in 33 patients with ET (untreated or off treatment with hydroxyurea), 28 patients with RT, and 16 normal volunteer controls. RESULTS We found IGF-1R levels were significantly elevated in ET patients compared to RT patients or controls. A cutoff value of 253 was chosen from the logistic regression to predict each patient's group, a value ≥253 meant that a patient belonged to the ET group (sensitivity 96.4% and specificity 68.6%). CONCLUSION We suggest that adding quantification of IGF-1R in blood MNC by flow cytometry is useful in differentiating ET from RT.
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Affiliation(s)
- Jen C Wang
- Division of Hematology/Oncology, Brookdale University Hospital Medical Center, Brooklyn, NY, USA
| | - Guanfang Shi
- Division of Hematology/Oncology, Brookdale University Hospital Medical Center, Brooklyn, NY, USA
| | - Ching Wong
- Division of Hematology/Oncology, Brookdale University Hospital Medical Center, Brooklyn, NY, USA
| | - Vladimir Gotlieb
- Division of Hematology/Oncology, Brookdale University Hospital Medical Center, Brooklyn, NY, USA
| | - Preethi Ramachandran
- Division of Hematology/Oncology, Brookdale University Hospital Medical Center, Brooklyn, NY, USA
| | - Hui Chen
- Division of Hematology/Oncology, Brookdale University Hospital Medical Center, Brooklyn, NY, USA
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12
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Abstract
Patient: Male, 55 Final Diagnosis: Auto-immune heparin thrombocytopenia -Treatment obstacles and challenging length of stay Symptoms: Thrombocytopenia • thrombosis Medication: — Clinical Procedure: IVIG Specialty: Hematology
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Affiliation(s)
- Preethi Ramachandran
- Division of Hematology and Medical Oncology, Brookdale University Hospital, Brooklyn, NY, USA
| | - Fady Farag
- Division of Hematology and Medical Oncology, Brookdale University Hospital, Brooklyn, NY, USA
| | - Rewais Morcus
- Division of Hematology and Medical Oncology, Brookdale University Hospital, Brooklyn, NY, USA
| | - Vladimir Gotlieb
- Division of Hematology and Medical Oncology, Brookdale University Hospital, Brooklyn, NY, USA
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13
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Wang JC, Chen C, Kundra A, Kodali S, Pandey A, Wong C, Cheung T, Gotlieb V, Joseph G, Tribie S. Programmed Cell Death Receptor (PD-1) Ligand (PD-L1) expression in Philadelphia chromosome-negative myeloproliferative neoplasms. Leuk Res 2019; 79:52-59. [PMID: 30851544 DOI: 10.1016/j.leukres.2019.02.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 02/25/2019] [Accepted: 02/27/2019] [Indexed: 02/04/2023]
Abstract
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.
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Affiliation(s)
- Jen-Chin Wang
- Division of Hematology/Oncology, Brookdale University Hospital Medical Center, Brooklyn, NY 11212, USA.
| | - Chi Chen
- Division of Hematology/Oncology, Brookdale University Hospital Medical Center, Brooklyn, NY 11212, USA
| | - Ajay Kundra
- Division of Hematology/Oncology, Brookdale University Hospital Medical Center, Brooklyn, NY 11212, USA
| | - Sreenath Kodali
- Division of Hematology/Oncology, Brookdale University Hospital Medical Center, Brooklyn, NY 11212, USA
| | - Anita Pandey
- Division of Hematology/Oncology, Brookdale University Hospital Medical Center, Brooklyn, NY 11212, USA
| | - Ching Wong
- Division of Hematology/Oncology, Brookdale University Hospital Medical Center, Brooklyn, NY 11212, USA
| | - Tony Cheung
- Division of Hematology/Oncology, Brookdale University Hospital Medical Center, Brooklyn, NY 11212, USA
| | - Vladimir Gotlieb
- Division of Hematology/Oncology, Brookdale University Hospital Medical Center, Brooklyn, NY 11212, USA
| | - Gardith Joseph
- Division of Hematology/Oncology, Brookdale University Hospital Medical Center, Brooklyn, NY 11212, USA
| | - Sophia Tribie
- Division of Hematology/Oncology, Brookdale University Hospital Medical Center, Brooklyn, NY 11212, USA
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14
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Jin C, Minhas H, Kaur A, Kodali S, Gotlieb V. A Case of Ocular Kaposi's Sarcoma Successfully Treated with Highly Active Antiretroviral Therapy (HAART) Combined with Docetaxel. Am J Case Rep 2018; 19:1074-1077. [PMID: 30197412 PMCID: PMC6140454 DOI: 10.12659/ajcr.910374] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Patient: Male, 24 Final Diagnosis: Ocular Kaposi’s sarcoma Symptoms: Eyelid swelling • red eye Medication: — Clinical Procedure: Biopsy Specialty: Oncology
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Affiliation(s)
- Chongfei Jin
- Department of Medicine, Brookdale University Hospital and Medical Center, Brooklyn, NY, USA.,Eye Center of the Second Affiliated Hospital, Medical College of Zhejiang University, Hangzhou, Zhejiang, China (mainland)
| | - Hamza Minhas
- Division of Hematology and Oncology, Brookdale University Hospital and Medical Center, Brooklyn, NY, USA
| | - Amandeep Kaur
- Department of Medicine, Brookdale University Hospital and Medical Center, Brooklyn, NY, USA
| | - Sreenath Kodali
- Division of Hematology and Oncology, Brookdale University Hospital and Medical Center, Brooklyn, NY, USA
| | - Vladimir Gotlieb
- Division of Hematology and Oncology, Brookdale University Hospital and Medical Center, Brooklyn, NY, USA
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15
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Minhas H, Abdelmalek C, Khan M, O'Donnell JE, Gotlieb V, Wang JC. Double-Hit Lymphoma (MYC and BCL6) with Involvement of Skull and Adnexal Lesions: A Case Report and a Review of the Literature. Am J Case Rep 2018; 19:1035-1041. [PMID: 30158513 PMCID: PMC6128191 DOI: 10.12659/ajcr.909400] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Double-hit lymphomas (DHL) belong to a category of very aggressive lymphomas characterized by MYC translocation and either BCL2, or less commonly, BCL6 translocations. Those with BCL6 translocations have a predilection for rare extranodal sites such as the gastrointestinal tract, nasopharynx, and tonsils. Involvement of the skull and adnexal structures is rare. Here we report a case of a young female with both skull and adnexal involvement. CASE REPORT A 20-year-old female who presented with hypercalcemia was found to have adnexal, skull, and jaw masses. Workup revealed a stage IV high grade B-cell lymphoma (HGBL) with MYC and BCL6 rearrangements. She was subsequently treated with R-EPOCH and attained complete remission 9 months after her initial presentation. To the best of our knowledge, our patient represents the first reported case of skull and adnexal involvement in HGBL with MYC and BCL6 rearrangement. CONCLUSIONS Rare extranodal presentations of HGBL with MYC and BCL6 rearrangement should be considered in the differential diagnosis of masses found in unusual sites such as the skull and adnexa. Due to their aggressive nature, early and prompt recognition of these lymphomas is essential for timely administration of appropriate therapy.
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Affiliation(s)
- Hamza Minhas
- Division of Hematology/Oncology, Brookdale Hospital Medical Center, Brooklyn, NY, USA
| | - Cherif Abdelmalek
- Division of Hematology/Oncology, Brookdale Hospital Medical Center, Brooklyn, NY, USA
| | - Marium Khan
- Department of Internal Medicine, Brookdale Hospital Medical Center, Brooklyn, NY, USA
| | - James E O'Donnell
- Department of Pathology, Brookdale Hospital Medical Center, Brooklyn, NY, USA
| | - Vladimir Gotlieb
- Division of Hematology/Oncology, Brookdale Hospital Medical Center, Brooklyn, NY, USA
| | - Jen Chin Wang
- Division of Hematology/Oncology, Brookdale Hospital Medical Center, Brooklyn, NY, USA
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16
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Xu J, Velayati A, Berger BJ, Liu M, Cheedella NKS, Gotlieb V. Leiomyosarcoma of the Inferior Vena Cava in an HIV-Positive Adult Patient: A Case Report and Review of the Literature. Am J Case Rep 2017; 18:1160-1165. [PMID: 29097650 PMCID: PMC5683681 DOI: 10.12659/ajcr.905787] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Patient: Female, 64 Final Diagnosis: IVC leiomyosarcoma Symptoms: Back pain • leg pain • leg swelling Medication: — Clinical Procedure: IVC filter placement • CT-guided IVC mass biopsy Specialty: Oncology
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Affiliation(s)
- Jing Xu
- Department of Internal Medicine, Brookdale University Hospital and Medical Center, Brooklyn, NY, USA
| | - Arash Velayati
- Department of Internal Medicine, Brookdale University Hospital and Medical Center, Brooklyn, NY, USA
| | - Barbara J Berger
- Department of Infectious Disease, Brookdale University Hospital and Medical Center, Brooklyn, NY, USA
| | - Ming Liu
- Department of Pathology, Brookdale University Hospital and Medical Center, Brooklyn, NY, USA
| | | | - Vladimir Gotlieb
- Department of Hematology/Oncology, Brookdale University Hospital and Medical Center, Brooklyn, NY, USA
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17
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Sokolova A, Mararenko A, Rozin A, Podrumar A, Gotlieb V. Hereditary persistence of hemoglobin F is protective against red cell sickling. A case report and brief review. Hematol Oncol Stem Cell Ther 2017; 12:215-219. [PMID: 29079125 DOI: 10.1016/j.hemonc.2017.09.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Revised: 09/09/2017] [Accepted: 09/21/2017] [Indexed: 10/18/2022] Open
Abstract
Fetal hemoglobin (HbF) is a physiologic protein tetramer that is crucial for a developing fetus to survive in utero. Maternal hemoglobin has a relatively lower affinity for oxygen, and thus allows for an efficient transfer of oxygen from maternal to fetal blood. In addition to fulfilling a critical physiologic role, HbF is also known to alleviate symptoms of sickle-cell disease (SCD). The concentration of HbF depends on several factors. HbF is elevated in inherited conditions, such as hereditary persistence of HbF, hereditary spherocytosis, and thalassemia. The level of HbF is also increased in acquired states, such as pregnancy, aplastic anemia, thyrotoxicosis, hepatoma, myeloproliferative disorders, or hypoplastic myelodysplastic syndrome. It has been identified that some genetic loci have significant influence on HbF levels. The XmnI polymorphism, the HMIP locus, and the BCL11A gene are responsible for 45% of variations in HbF levels. Although SCD has been well described in the subpopulations of Africa, it is less common in the subpopulations of India. We describe a case of SCD, in which a patient with high HbF level presented at a very late age (27 years old). We presume the patient's inherently elevated HbF levels were able to compensate for the hypoxic episodes associated with SCD. The onset of symptoms was delayed as a result of elevated HbF levels.
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Affiliation(s)
- Alexandra Sokolova
- Nassau University Medical Center, Department of Medicine, 2201 Hempstead Turnpike, East Meadow, NY 11554, United States
| | - Anton Mararenko
- New York Institute of Technology College of Osteopathic Medicine, 101 Northern Blvd, Glen Head, NY 11545, United States
| | - Alexander Rozin
- Brookdale University Medical Center, Department of Medicine, Division of Hematology-Oncology, 1 Brookdale Plaza, Brooklyn, NY 11212, United States
| | - Alida Podrumar
- Nassau University Medical Center, Department of Medicine, 2201 Hempstead Turnpike, East Meadow, NY 11554, United States
| | - Vladimir Gotlieb
- Brookdale University Medical Center, Department of Medicine, Division of Hematology-Oncology, 1 Brookdale Plaza, Brooklyn, NY 11212, United States.
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18
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Andrei M, Bandarchuk A, Abdelmalek C, Kundra A, Gotlieb V, Wang JC. PDGFRᵝ-Rearranged Myeloid Neoplasm with Marked Eosinophilia in a 37-Year-Old Man; And a Literature Review. Am J Case Rep 2017; 18:173-180. [PMID: 28209946 PMCID: PMC5325042 DOI: 10.12659/ajcr.900623] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Patient: Male, 37 Final Diagnosis: PDGFRβ-rearranged myeloid neoplasm with eosinophilia Symptoms: Night sweats • weight loss Medication: — Clinical Procedure: — Specialty: Hematology
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Affiliation(s)
- Mirela Andrei
- Division of Hematology and Oncology, Brookdale University Hospital and Medical Center, Brooklyn, USA
| | - Andrei Bandarchuk
- Division of Hematology and Oncology, Brookdale University Hospital and Medical Center, Brooklyn, USA
| | - Cherif Abdelmalek
- Division of Hematology and Oncology, Brookdale University Hospital and Medical Center, Brooklyn, USA
| | - Ajay Kundra
- Division of Hematology and Oncology, Brookdale University Hospital and Medical Center, Brooklyn, USA
| | - Vladimir Gotlieb
- Division of Hematology and Oncology, Brookdale University Hospital and Medical Center, Brooklyn, USA
| | - Jen Chin Wang
- Division of Hematology and Oncology, Brookdale University Hospital and Medical Center, Brooklyn, USA
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19
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Tan B, Abdelmalek C, O'Donnell JE, Toltaku T, Chaudhry R, Wang JC, Gotlieb V. A Case Report of Primary Nasal Natural Killer (NK)/T-Cell Lymphoma in an African American Patient Presenting with Hemophagocytic Syndrome. Am J Case Rep 2017; 18:160-165. [PMID: 28193996 PMCID: PMC5319307 DOI: 10.12659/ajcr.900995] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Patient: Male, 55 Final Diagnosis: Primary NK-T cell lymphoma • nasal type Symptoms: Fever • nasal bleeding • nasal mass • weight loss Medication: — Clinical Procedure: Chemotherapy×2 cycles • radiation therap Specialty: Oncology
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Affiliation(s)
- Bowei Tan
- Department of Medicine, Brookdale University Hospital and Medical Center, Brooklyn, NY, USA
| | - Cherif Abdelmalek
- Department of Medicine, Brookdale University Hospital and Medical Center, Brooklyn, NY, USA
| | - James E O'Donnell
- Department of Medicine, Brookdale University Hospital and Medical Center, Brooklyn, NY, USA
| | - Thomas Toltaku
- Department of Medicine, Brookdale University Hospital and Medical Center, Brooklyn, NY, USA
| | - Rashid Chaudhry
- Department of Medicine, Brookdale University Hospital and Medical Center, Brooklyn, NY, USA
| | - Jen C Wang
- Department of Medicine, Brookdale University Hospital and Medical Center, Brooklyn, NY, USA
| | - Vladimir Gotlieb
- Department of Medicine, Brookdale University Hospital and Medical Center, Brooklyn, NY, USA
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20
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Wang JC, Shi G, Baptiste S, Yarotska M, Sindhu H, Wong C, Kalavar M, Gotlieb V, Bandarchuk A, Chen H. Quantification of IGF-1 Receptor May Be Useful in Diagnosing Polycythemia Vera-Suggestion to Be Added to Be One of the Minor Criterion. PLoS One 2016; 11:e0165299. [PMID: 27812134 PMCID: PMC5094699 DOI: 10.1371/journal.pone.0165299] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Accepted: 10/10/2016] [Indexed: 01/12/2023] Open
Abstract
Endogenous erythroid colony (EEC) formation is one of the minor criteria for diagnosing polycythemia vera (PV) according to 2008 WHO diagnostic criteria. But EEC requires bone marrow aspiration and sophisticated laboratory procedures; therefore, practically it is rarely used to diagnose PV. Insulin-like growth factor 1 receptor (IGF-1R) was found to be constitutively phosphorylated and was responsible for the EEC formation in PV; therefore, we measured IGF-1R levels in the peripheral blood of 26 PV patients and compared them with those of 33 patients with secondary polycythemia and 29 normal controls. Among the PV patients, 16 were treated with only phlebotomy, 9 received hydroxyurea, and 1 was treated with ruxolinitinib. We found that PV patients treated with only phlebotomy had significantly higher IGF-1R levels than did those PV patients treated with hydroxyurea or ruxolinitinib. None of the secondary PV patients or normal controls had elevated IGR-1R levels, while 14 of 16 (87%) PV patients had significantly elevated IGF-1R levels. The new 2016 WHO has eliminated EEC as a minor criterion for diagnosing PV, but there are still some cases that cannot be definitively diagnosed by the current criteria. Therefore, we suggest that quantifying the IGF-1R level in peripheral blood by flow cytometry to replace EEC as the minor criterion for diagnosing PV.
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Affiliation(s)
- Jen C. Wang
- Division of Hematology/Oncology, Brookdale University Hospital Medical Center, Brooklyn, NY, United States of America
- * E-mail:
| | - Guanfang Shi
- Division of Hematology/Oncology, Brookdale University Hospital Medical Center, Brooklyn, NY, United States of America
| | - Stacey Baptiste
- Division of Hematology/Oncology, Brookdale University Hospital Medical Center, Brooklyn, NY, United States of America
| | - Maryna Yarotska
- Division of Hematology/Oncology, Brookdale University Hospital Medical Center, Brooklyn, NY, United States of America
| | - Hemant Sindhu
- Division of Hematology/Oncology, Brookdale University Hospital Medical Center, Brooklyn, NY, United States of America
| | - Ching Wong
- Division of Hematology/Oncology, Brookdale University Hospital Medical Center, Brooklyn, NY, United States of America
| | - Madhumati Kalavar
- Division of Hematology/Oncology, Brookdale University Hospital Medical Center, Brooklyn, NY, United States of America
| | - Vladimir Gotlieb
- Division of Hematology/Oncology, Brookdale University Hospital Medical Center, Brooklyn, NY, United States of America
| | - Andrei Bandarchuk
- Division of Hematology/Oncology, Brookdale University Hospital Medical Center, Brooklyn, NY, United States of America
| | - Hui Chen
- Division of Hematology/Oncology, Brookdale University Hospital Medical Center, Brooklyn, NY, United States of America
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21
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Zhu Z, Chen H, Gill R, Wang J, Spitalewitz S, Gotlieb V. Diabetic ketoacidosis presenting with atypical hemolytic uremic syndrome associated with a variant of complement factor B in an adult: a case report. J Med Case Rep 2016; 10:38. [PMID: 26911616 PMCID: PMC4765089 DOI: 10.1186/s13256-016-0825-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Accepted: 01/30/2016] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Non-Shiga toxin-associated hemolytic uremic syndrome is known to be caused by dysregulation of the alternative complement pathway. Infections, drugs, pregnancy, bone marrow transplantation, malignancy, and autoimmune disorders have all been reported to trigger episodes of atypical hemolytic uremic syndrome. To the best of our knowledge, there have been no previous reports of an association between diabetic ketoacidosis and atypical hemolytic uremic syndrome. CASE PRESENTATION We describe a case of a 26-year-old Spanish man who presented with diabetic ketoacidosis and was found to have the triad of microangiopathic hemolytic anemia, thrombocytopenia, and acute kidney injury. The patient had a normal ADAMTS13 (a disintegrin and metalloproteinase with a thrombospondin type 1 motif, member 13) activity level, and his renal biopsy demonstrated predominant changes of diabetic glomerulosclerosis with an area compatible with thrombotic microangiopathy suggestive of superimposed atypical hemolytic uremic syndrome. Complement sequencing subsequently revealed a potential causative mutation in exon 12 of complement factor B with changes of lysine at amino acid position 533 to an arginine (CFB p.K533R). CONCLUSIONS To the best of our knowledge, this is the first case report of diabetic ketoacidosis presenting with atypical hemolytic uremic syndrome associated with a variant of complement factor B in an adult patient.
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Affiliation(s)
- Ziqiang Zhu
- Department of Internal Medicine, Brookdale University Hospital and Medical Center, One Brookdale Plaza, Brooklyn, NY, 11212, USA.
| | - Hui Chen
- Division of Hematology/Oncology, Brookdale University Hospital and Medical Center, One Brookdale Plaza, Brooklyn, NY, 11212, USA.
| | - Rupinder Gill
- Division of Nephrology, Brookdale University Hospital and Medical Center, One Brookdale Plaza, Brooklyn, NY, 11212, USA.
| | - Jenchin Wang
- Division of Hematology/Oncology, Brookdale University Hospital and Medical Center, One Brookdale Plaza, Brooklyn, NY, 11212, USA.
| | - Samuel Spitalewitz
- Division of Nephrology, Brookdale University Hospital and Medical Center, One Brookdale Plaza, Brooklyn, NY, 11212, USA.
| | - Vladimir Gotlieb
- Division of Hematology/Oncology, Brookdale University Hospital and Medical Center, One Brookdale Plaza, Brooklyn, NY, 11212, USA.
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22
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Reiser IW, Ali S, Gotlieb V, Spitalewitz S. Hypercalcemia-Induced Hypokalemic Metabolic Alkalosis in a Multiple Myeloma Patient: The Risk of Furosemide Use. Case Rep Oncol 2015; 8:389-93. [PMID: 26500541 PMCID: PMC4608639 DOI: 10.1159/000439377] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Hypercalcemia is often seen in patients with malignancies, and in the past treatment for this has traditionally included loop diuretics. Clinically, patients with hypercalcemia frequently present with polyuria and volume contraction which may be further exacerbated by diuretic therapy. In the lab, hypercalcemia has been shown to activate the calcium-sensing receptor in the thick ascending limb of Henle and inactivate the 2 chloride sodium potassium co-transporter and induce a hypokalemic metabolic alkalosis, an effect similar to that of the loop diuretic furosemide. We now report what may well be the first clinical correlate of this laboratory finding in a patient who developed a hypokalemic metabolic alkalosis as a consequence of severe hypercalcemia due to multiple myeloma and whose metabolic derangement was corrected without the use of a loop diuretic which may have exacerbated the electrolyte abnormalities.
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Affiliation(s)
- Ira W Reiser
- State University of New York Health Science Center at Brooklyn, Brookdale University Hospital and Medical Center, N.Y., USA ; Division of Nephrology and Hypertension, Brookdale University Hospital and Medical Center, N.Y., USA
| | - Slamat Ali
- Division of Brookdale University Hospital and Medical Center, Brooklyn, N.Y., USA
| | - Vladimir Gotlieb
- State University of New York Health Science Center at Brooklyn, Brookdale University Hospital and Medical Center, N.Y., USA ; Division of Hematology and Oncology, Department of Medicine, Brookdale University Hospital and Medical Center, N.Y., USA
| | - Samuel Spitalewitz
- State University of New York Health Science Center at Brooklyn, Brookdale University Hospital and Medical Center, N.Y., USA ; Division of Nephrology and Hypertension, Brookdale University Hospital and Medical Center, N.Y., USA
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23
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Chen H, Wu S, Kundra A, Aja Onu I, Gotlieb V, Wang JC. Gastric Perforation in a Patient Receiving Neoadjuvant Chemoradiotherapy. World J Oncol 2015; 6:383-386. [PMID: 28983335 PMCID: PMC5624666 DOI: 10.14740/wjon924w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/25/2015] [Indexed: 12/21/2022] Open
Abstract
Perioperative chemoradiotherapy is considered to be one of the standards of care for early-stage gastric cancer, especially when it involves the esophagogastric junction or greater curvature. To date, there are no reported cases of gastrointestinal perforation in the literature, including many major clinical trials of adjuvant or neoadjuvant chemoradiotherapy for gastric cancer. It is important to recognize and manage this rare, but fatal complication in a timely manner. We report one case of gastrointestinal perforation in a gastric cancer patient undergoing neoadjuvant chemoradiotherapy with 5-fluorouracil and oxaliplatin. A 75-year-old man was diagnosed with stage IV gastric cancer (T4N1M0). We started neoadjuvant chemoradiotherapy with 5-fluorouracil and oxaliplatin. After he finished the first cycle, the patient presented to emergency room with severe abdominal pain of sudden onset. Computed tomography showed moderate pneumoperitoneum and perihepatic fluid. The patient expired 6 hours after he presented to emergency room.
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Affiliation(s)
- Hui Chen
- Division of Hematology/Oncology, Brookdale University Hospital Medical Center, Brooklyn, NY, USA
| | - Susan Wu
- Department of Pathology, South Nassau Communities Hospital, Oceanside, NY, USA
| | - Ajay Kundra
- Division of Hematology/Oncology, Brookdale University Hospital Medical Center, Brooklyn, NY, USA
| | - Iheanyichukwu Aja Onu
- Department of Gastroenterology, South Nassau Communities Hospital, Oceanside, NY, USA
| | - Vladimir Gotlieb
- Division of Hematology/Oncology, Brookdale University Hospital Medical Center, Brooklyn, NY, USA
| | - Jen C Wang
- Division of Hematology/Oncology, Brookdale University Hospital Medical Center, Brooklyn, NY, USA
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24
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Li L, Schuster IP, Jacob R, Hupart KH, Gotlieb V. Potential benefit of hormonal therapy for non-uterine soft tissue sarcoma (STS) - a case report and literature review. Springerplus 2013; 2:536. [PMID: 24255838 PMCID: PMC3825229 DOI: 10.1186/2193-1801-2-536] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/02/2013] [Accepted: 10/04/2013] [Indexed: 11/21/2022]
Abstract
The expression of hormone receptors (HR) is considered a good prognostic marker in uterine sarcoma. Hormonal therapy is widely employed in the therapy of HR positive breast and gynecologic cancers, however, there is little information concerning hormonal therapy in HR positive extrauterine sarcoma. A 55-60 year age group female presented with an estrogen receptor positive metastatic retroperitoneal leiomyosarcoma (LMS). She was treated with four cycles of a combination of Gemcitabine and Paclitaxel. Her disease remained stable for 29 months when tamoxifen was initiated. The patient succumbed to an unrelated malignancy after a total of 44 months of treatment. Despite emerging reports about the potential benefit of hormonal therapy, selective estrogen and progesterone receptor modulators and aromatase inhibitors, for uterine sarcoma, there is a paucity of information regarding the application of these therapies to sarcomas arising at other sites. Our patient survived significantly longer than expected with metastatic retroperitoneal sarcoma. In part this may be due to the survival benefit associated with HR positive tumors, but it may also indicate a role for hormonal therapy which has yet to be explored.
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Affiliation(s)
- Li Li
- Department of Medicine, Nassau University Medical Center, East Meadow, NY USA
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Gao L, Joseph J, Levy-Santoro M, Gotlieb V, Multz AS. Utilization of prescription-assistance program for medically uninsured cancer patients: A case study of a public hospital experience in New York state. J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.e17537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e17537 Background: With the advances in early detection, prevention, and treatment of some cancers, mortality rates in the United States have been consistently falling. However, with these successes have come substantial increases in the cost of cancer care. Antineoplastics are the leading therapeutic classes in hospital drug expenditures. Lack of insurance is associated with lower rates of cancer screening, later stage at diagnosis, and increased cancer mortality. Prescription assistance programs (PAPs) are offered by pharmaceutical manufacturers to provide medications at no out-of-pocket cost to medically indigent patients. To assist the Cancer Care Center at NUMC with drug costs for chemotherapies and maintain the quality care for patients, the Pharmacy department instituted a Patient Assistance Program (PAP) to obtain medication from the drug companies at no cost. NUMC is a “safety net” teaching hospital in suburban New York. It serves mostly an indigent population and is a Level 1 Trauma Center with over 77,000 emergency department visits per year. Methods: We followed all patients requiring assistance with chemotherapy who enrolled in our PAPs from January 1, 2011 to December 31, 2012. Individuals potentially eligible for PAPs were identified by Oncologists and by the pharmacy department. Medications included both oral and parenteral chemotherapy drugs and antiemetics. Results: The program served 341 patients in 2011 and 579 patients in 2012. The total number of visits in the clinic over 24 months was 9,405. The total cost savings of the medications was $908,944.11 in 2011 and $1,715,538.37 in 2012. Conclusions: PAPs provide a valuable safety net to ensure that cancer patients without insurance receive needed prescription medications. The rising cost of health care and the high proportion of indigent patients have financially burdened the hospital. A pharmacy-based program to procure free medications for uninsured cancer outpatients has helped to defray the Cancer Care Center’s expense of providing care at NUMC, increased patients’ compliance with chemo-protocols and allowed many patients to receive the treatment they otherwise would not be able to afford.
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Affiliation(s)
- Limin Gao
- Nassau University Medical Center, East Meadow, NY
| | - Jivin Joseph
- Nassau University Medical Center, East Meadow, NY
| | | | - Vladimir Gotlieb
- Division of Hematology and Oncology, Department of Medicine, Nassau University Medical Center, East Meadow, NY
| | - Alan S. Multz
- Division of Hematology and Oncology, Department of Medicine, Nassau University Medical Center, East Meadow, NY
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Pathak P, Zilberman V, Avezbakiyev B, Gotlieb V. Hairy cell leukemia in a patient with situs inversus totalis: an extremely rare combination. Future Oncol 2013; 9:753-6. [PMID: 23647303 DOI: 10.2217/fon.13.23] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Hairy cell leukemia is a rare cancer of the blood. The occurrence of hairy cell leukemia with another very rare genetic disorder makes us question whether it is just a coincidence. This article reports the first case of hairy cell leukemia in a patient with situs inversus totalis in western literature. There have been studies into the pathogenesis of situs inversus totalis that suggest it is caused by the failure of embryonic cells to properly rotate during embryogenesis. On the molecular level, the nodal cilia, which are responsible for embryonic rotation, are built by transport through the KIF3 complex - a kinesin superfamily of molecular motors. The KIF3 complex is also responsible for N-cadherin movement in cells. Furthermore, it is well known that these cell adhesion molecules play an important role in carcinogenesis and its progression. This report attempts to link the rare conditions and propose a possible genetic relationship between the two.
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Affiliation(s)
- Prajwol Pathak
- Department of Internal Medicine/Hematology & Oncology, Nassau University Medical Center, NY, USA.
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Fu S, Avezbakiyev B, Zhi W, Kodali S, Rizvon K, Alaverdian A, Freedman L, Mejia J, Shahzad G, Gotlieb V. Germ cell cancer presenting as gastrointestinal bleeding and developing brain metastases: case report and review of the literature. Future Oncol 2013; 8:1487-93. [PMID: 23148621 DOI: 10.2217/fon.12.133] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
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 β-human chorionic gonadotropin and lung involvement).
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Affiliation(s)
- Shuang Fu
- Department of Medicine, Nassau University Medical Center, 2201 Hempstead Turnpike, East Meadow, NY 11554, USA
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Hurtado-Cordovi JM, Verma V, Gotlieb V, Frieri M. Lymphocyte Rich Hodgkin's Lymphoma Presented with Warm Hemolytic Anemia: A Case Report and Literature Review. Case Rep Hematol 2011; 2011:385408. [PMID: 22937306 PMCID: PMC3420746 DOI: 10.1155/2011/385408] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2011] [Accepted: 07/13/2011] [Indexed: 01/20/2023] Open
Abstract
Hodgkin's lymphoma accounts for ten percent of all lymphomas. In the United States, there are about 8000 new cases every year. This paper describes a case of lymphocyte-rich Hodgkin's lymphoma (LRHL) manifested by autoimmune hemolytic anemia (AIHA). A 27-year-old Israeli male presented with dizziness associated with one month of low-grade fevers and night sweats; he also complained of persistent cough, pruritus, and ten-pound weight lost during this time. The CBC revealed hemoglobin of 5.9 gm/dL, and direct Coomb's test detected multiple nonspecific antibodies consistent with the diagnosis of AIHA. Chest, abdomen, and pelvic CT scan showed mediastinal lymphadenopathy and splenomegaly. Lymph node biopsy revealed classic LRHL. AIHA resolved after completion of the first cycle of chemotherapy with adriamycin, bleomycin, vinblastine, and dacarbazine (ABVD); after six cycles, he went into complete remission. Although infrequent, AIHA can be responsible for the presenting symptoms of HL.
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Affiliation(s)
- Jorge M Hurtado-Cordovi
- Divisions of Hematology and Oncology and Allergy and Immunology, Department of Medicine, Nassau University Medical Center, 2201 Hempstead Turnpike, East Meadow, NY 11554, USA
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Ruoff C, Hanna L, Zhi W, Shahzad G, Gotlieb V, Saif MW. Cancers of the appendix: review of the literatures. ISRN Oncol 2011; 2011:728579. [PMID: 22084738 PMCID: PMC3200132 DOI: 10.5402/2011/728579] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/24/2011] [Accepted: 06/26/2011] [Indexed: 11/23/2022]
Abstract
Cancers of the appendix are rare. Most of them are found accidentally on appendectomies performed for appendicitis. When reviewed, majority of the tumors were carcinoid, adenoma, and lymphoma. Adenocarcinomas of appendix are only 0.08% of all cancers and the treatment remains controversial. Here we are reporting a 46-year-old male presented with symptoms of appendicitis, diagnosed with adenocarcinoma of the appendix. The patient was treated with appendectomy and refused further surgical intervention to complete hemicolectomy. Up to date, he remains asymptomatic. We performed literature review of the tumors of the appendix. Most of the benign conditions are treated with surgery alone. Lymphomas require CHOP-like chemotherapy and carcinoid syndrome treatment with somatostatin analogues. It is generally recommended that right hemicolectomy is the preferred treatment for adenocarcinoma of appendix. The role of chemotherapy is unclear due to lacking randomized trials but seems to be accepted if there is lymph node involvement or peritoneal seeding.
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Affiliation(s)
- Carl Ruoff
- New York Hospital Medical Center of Queens, Flushing, NY 11355, USA
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Gotlieb V, Verma V, Fogel J, Multz A, Gralla RJ. Comparative analysis of lung cancer in a public hospital versus private hospitals in New York. J Clin Oncol 2011; 29:6037-6037. [DOI: https:/doi.org/10.1200/jco.2011.29.15_suppl.6037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2024] Open
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Gotlieb V, Verma V, Fogel J, Multz A, Gralla RJ. Comparative analysis of lung cancer in a public hospital versus private hospitals in New York. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.6037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Bulathsinghala PC, Gevorgyan A, Gotlieb V, Saif MW. An unusual case of “jaundice”. Cutan Ocul Toxicol 2010; 29:74-5. [DOI: 10.3109/15569520903178224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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C. Bulathsinghala P, Gevorgyan A, Gotlieb V, Saif MW. An unusual case of “jaundice”. Cutan Ocul Toxicol 2009. [DOI: 10.1080/15569520903178224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Khaled S, Gotlieb V, Schuster IP, Saif MW. Multiple lymphomatous polyposis associated with small lymphocytic lymphoma: a unique presentation. J Gastrointestin Liver Dis 2008; 17:461-463. [PMID: 19104711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Multiple lymphomatous polyposis (MLP) is a rare extra-nodal manifestation of lymphoma. In most cases, MLP is associated with mantle cell lymphoma (MCL). We report a 66-year-old male diagnosed with small lymphocytic lymphoma (SLL)/chronic lymphocytic lymphoma (CLL), who showed evidence of rectal bleeding. A CT-scan of the abdomen and pelvis showed an enlarged spleen, multiple paraaortic and mesenteric lymph nodes, and some diverticular pouching along the antimesenteric border of the pelvic colon. A colonoscopy revealed the presence of multiple polypoid lesions, biopsies of which showed diffuse lymphoid infiltrate without any identifiable follicles. Immunohistochemical analysis combined with a Fluorescence In-Situ Hybridization (FISH) study excluded the diagnosis of MCL. A bone marrow aspiration biopsy demonstrated diffuse infiltration of the bone marrow with low grade lymphocytes that expressed CD 20, CD5 and CD23, with negative BCL-1, t (11; 14) and cyclin D1. A diagnosis of B-cell CLL with kappa light chain restriction was made. Multiple lymphomatous polyposis is considered to be a digestive counterpart to MCL and can therefore be considered as a presentation of MCL. In our case, the polypoid lesions failed to show the characteristic features of MCL. The patient's bone marrow revealed a B-cell lymphoma of CLL/SLL phenotype, which to our knowledge has not been linked to MLP in previously reported cases.
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MESH Headings
- Aged
- B-Lymphocytes/metabolism
- Biomarkers, Tumor/metabolism
- Bone Marrow/pathology
- Colonic Polyps/complications
- Colonic Polyps/diagnosis
- Colonic Polyps/metabolism
- Colonic Polyps/pathology
- Colorectal Neoplasms/complications
- Colorectal Neoplasms/diagnosis
- Colorectal Neoplasms/metabolism
- Colorectal Neoplasms/pathology
- Diagnosis, Differential
- Humans
- Leukemia, Lymphocytic, Chronic, B-Cell/complications
- Leukemia, Lymphocytic, Chronic, B-Cell/diagnosis
- Leukemia, Lymphocytic, Chronic, B-Cell/metabolism
- Leukemia, Lymphocytic, Chronic, B-Cell/pathology
- Lymphoma, Mantle-Cell/complications
- Lymphoma, Mantle-Cell/diagnosis
- Lymphoma, Mantle-Cell/metabolism
- Lymphoma, Mantle-Cell/pathology
- Male
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Affiliation(s)
- Samer Khaled
- The Brooklyn Hospital Center of Cornell Medical College, Brooklyn, NY; Section of Medical Oncology Yale University School of Medicine 333 Cedar str, FMP, 116, New Haven, CT 06520, USA
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Damerla V, Gotlieb V, Larson H, Saif MW. Pancreatic enzyme supplementation in pancreatic cancer. J Support Oncol 2008; 6:393-396. [PMID: 19149324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
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Ahluwalia M, Gotlieb V, Damerla V, Saif MW. Aggressive Burkitt-like lymphoma of colon in a patient with prior celiac disease. Yale J Biol Med 2006; 79:173-5. [PMID: 17940628 PMCID: PMC1994793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Celiac disease (CD) and immunosuppression are the two risk factors for gastrointestinal, as well as non-gastrointestinal, non-Hodgkin's lymphomas (NHL). Recent large retrospective studies confirm that celiac disease significantly increases risk of developing small bowel lymphomas by 30 to 40 percent and other gut malignancies by 83-fold. CASE REPORT A 75-year-old man with a history of CD of two-year duration presented with pallor, fatigue, and 20-pound weight loss of three weeks duration. There was a vague non-tender mass in the right hypochondrium, and his stools tested positive for occult blood. The lab values were within normal range, except for hemoglobin of 11mg/dL, MCV 75, mildly elevated SGOT of 61 IU/L, and LDH of about 5000 IU/L. Work-up including computerized tomography (CT) scan, positron emission tomography (PET) scan, and colonoscopy were performed. RESULTS A CT scan of the abdomen showed extensive carcinomatosis, scattered lymphadenopathy, and small pleural effusions. PET scan results coincided with CT findings. Colonoscopy revealed a friable nodular mass in the hepatic flexure, histopathology of which confirmed a high-grade B-cell lymphoma. Flow cytometry following immunostaining was positive for CD10, CD19, CD20, CD45, CD79a, and Ki-67. FISH assay demonstrated t (14:18) translocation and bcl-2 rearrangement. The bone marrow biopsy showed evidence of disease. The patient was treated with rituximab, plus cyclophosphamide, Adriamycin, vincristine, and prednisone (CHOP-R), with intrathecal methotrexate prophylaxis. Currently, the patient remains in remission. CONCLUSION This is the first case of aggressive Burkitt-like lymphoma (BLL) occurring in a patient with celiac disease in his eighth decade of life. It is possible that chronic inflammation, profound immunosuppression, and nutritional deficit could lead to development of high-grade B-cell lymphoproliferative disorders. Further molecular studies are warranted to the investigate the link between certain polymorphisms of human leukocyte antigens (HLA) in B-cell populations in the gut, and this might be useful to identify high-risk individuals in the population of patients with CD.
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Affiliation(s)
- M. Ahluwalia
- Hematology and Oncology, Brooklyn Hospital Center, Brooklyn, New York
| | - V. Gotlieb
- Hematology and Oncology, Brooklyn Hospital Center, Brooklyn, New York
| | - V. Damerla
- Flushing Hospital Medical Center, Flushing, New York
| | - M. Wasif Saif
- Yale Cancer Center, Yale University School of Medicine, New Haven, Connecticut,To whom all correspondence should be addressed: M. Wasif Saif, MD, MBBS, Associate Professor, Yale University School of Medicine, Section of Medical Oncology, 333 Cedar Street; FMP 116, New Haven, CT 06520; Tel: 203-737-1875; Fax: 203-785-3788; E-mail:
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Mar N, Khaled S, Kencana F, Gergis U, Khattak F, Brodsky N, Gotlieb V. Multiple lymphomatous polyposis as a sole presentation of mantle cell lymphoma. J Clin Gastroenterol 2006; 40:653-4. [PMID: 16917415 DOI: 10.1097/00004836-200608000-00022] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
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