Uncommon Presentation of Metastatic Squamous Cell Carcinoma of the Skin and Treatment Challenges

Patient: Female, 80

Final Diagnosis: Metastatic squamous cell carcinoma of skin

Symptoms: Back pain • leg swelling • uti

Medication: —

Clinical Procedure: Immunotherapy

Specialty: Oncology

Double-Hit Lymphoma (MYC and BCL6) with Involvement of Skull and Adnexal Lesions: A Case Report and a Review of the Literature

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.

Primary Pulmonary Diffuse Large B Cell Non-Hodgkin's Lymphoma: A Case Report and Literature Review

Patient: Female, 48

Final Diagnosis: Primary pulmonary DLBCL

Symptoms: Cough • weigh loss

Medication: R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone)

Clinical Procedure: Bone marrow biopsy • CT-guided lung biopsy

Specialty: Oncology

A Case Report of Primary Nasal Natural Killer (NK)/T-Cell Lymphoma in an African American Patient Presenting with Hemophagocytic Syndrome

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

E2 interference effects in the 12C(α,γ0)16O reaction

The E1-E2 interference sign between the E(c.m.)=2.68-MeV E2 resonance and an underlying E1 strength has been measured for the first time. An E1-E2 asymmetry parameter of a=0.07±0.05 was extracted from the thick-target γ-ray yields of the narrow resonance at angles of 45° and 135°. The positive sign of a corresponded to constructive interference at forward angles and, further, allowed the interference between the resonance and an E2 background to be identified as constructive below the resonance energy. The E2-E2 interference was then used to evaluate the global S(E2) data within the vicinity of the resonance 2.5≤E(c.m.)≤3.0  MeV. An analysis of the global S(E2) data that agreed with the interference scenario has determined the E2-E2 interference scheme of the 4.34-MeV resonance and background, resulting in a value of S(E2)(300)=62(-6)(+9)  keV b.

Aminoacid infusion induced depression of serum folate after cholecystectomy

Aminoacid solutions were given to cholecystectomy patients for a period of 48 h starting 24 h after the operation. Infusion of the aminoacid component of parenteral nutrition regimens, without calorie source, frequently led to an acute fall in the serum folate concentration. The degree of depression varied with different commercial aminoacid solutions. (Aminoplex 14 = c.60%, Vamin = 30%, Aminosol = c.0%). The folate depression by Vamin infusion was unaffected by supplementation with L-methione but was alleviated by the addition of glycine. As a consequence of surgical operation itself, folate values fell by 37% during the 24 h following cholecystectomy. This seems likely to increase the risk of haematological toxicity (i.e. acute leukopenia and thrombocytopenia) in patients given folate-free parenteral nutrition after a surgical operation.

Acute depression of serum folate in surgical patients during preoperative infusion of ethanol-free parenteral nutrition

Total parenteral nutrition for 48 h with Aminoplex solutions and a calorie source led to statistically similar, severe depression of the serum folate concentration (by 63-77%) irrespective of whether the calorie source contained ethanol, sorbitol, lipid or glucose. Folate levels were also depressed following infusion of other ethanol-free regimens (Freamine and glucose, 59%; Vamin and glucose, 44%). Least depression (31%0 followed use of Aminosol and glucose, a regimen based on casein hydrolysate. It seems important, therefore, to give prophylactic folate to all patients receiving parenteral nutrition, regardless of whether the calorie source is ethanol.

Fiberoptic endoscopy of the respiratory tract in the intensive care ward

An outline is given of the use of fiberoptic instruments in the management of some respiratory problems in the Intensive Care Ward. In particular, bronchoscopy and inspection of the trachea and larynx prior to closure of tracheostomy are described.