A 59-year-old woman presented with acute appendicitis. Further workup revealed she had acute myeloid leukemia (AML) with infiltration of the appendix. A bone marrow biopsy confirmed AML. She underwent an appendectomy and began chemotherapy, resulting in remission of the AML. However, the AML relapsed after two months and she ultimately passed away 185 days after initial presentation. This rare case demonstrates AML initially presenting as acute appendicitis due to leukemic infiltration of the appendix. Prompt treatment of both the appendicitis and AML resulted in longer survival compared to similar prior cases.
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Update on Patterns of Study in ANCA Associated Vasculitis presented at regional Northern Ireland Nephrology Meeting with Dr David Jayne as guest speaker..
Abstract
Hepatic angiosarcoma is a rare tumour that is often difficult to diagnose. Historically, most cases of hepatic angiosarcoma were seen in the setting of industrial epidemics caused by exposure of workers to toxins such as vinyl chloride. Cases associated with recognised exposure to carcinogens have fortunately been extremely rare for the last three or more decades. However, the tumour has by no means disappeared in the Australian community. In this case series, we describe three cases of hepatic angiosarcoma that were seen at our institution since 2002. The first case presented with cholestatic liver function tests and was found to have angiosarcoma on liver biopsy. In the second case, the patient was admitted for decompensated liver disease on a background of presumed hepatitis B cirrhosis. The diagnosis of hepatic angiosarcoma was made only at autopsy after the patient died from multi-organ failure. The third case presented with ascites and the diagnosis of disseminated angiosarcoma was again made at autopsy following a negative ante-mortem liver biopsy.
Update on Patterns of Study in ANCA Associated Vasculitis presented at regional Northern Ireland Nephrology Meeting with Dr David Jayne as guest speaker..
Abstract
Hepatic angiosarcoma is a rare tumour that is often difficult to diagnose. Historically, most cases of hepatic angiosarcoma were seen in the setting of industrial epidemics caused by exposure of workers to toxins such as vinyl chloride. Cases associated with recognised exposure to carcinogens have fortunately been extremely rare for the last three or more decades. However, the tumour has by no means disappeared in the Australian community. In this case series, we describe three cases of hepatic angiosarcoma that were seen at our institution since 2002. The first case presented with cholestatic liver function tests and was found to have angiosarcoma on liver biopsy. In the second case, the patient was admitted for decompensated liver disease on a background of presumed hepatitis B cirrhosis. The diagnosis of hepatic angiosarcoma was made only at autopsy after the patient died from multi-organ failure. The third case presented with ascites and the diagnosis of disseminated angiosarcoma was again made at autopsy following a negative ante-mortem liver biopsy.
Abdominal Pain as Initial Presentation of Lung Adenocarcinomaasclepiuspdfs
Isolated celiac lymph node metastasis (ICLNM), in general, is not common with a reported incidence of 5–10% for lung adenocarcinoma. Lung adenocarcinoma rarely metastasizes to the celiac lymph node leading to abdominal pain. It is not typical for ICLNM to be the initial presentation of lung adenocarcinoma as well. In this case, a 56-year-old man presented with a 4-week history of persistent periumbilical dull pain. Workup was remarkable for celiac lymph node mass which turned out to be adenocarcinoma with unknown primary cancer. Whole body position emission tomography scan and biopsy of the mass with immunohistochemistry could identify lung adenocarcinoma as the primary cancer. After a well-informed discussion of options for chemotherapy drugs with the patient, the decision was made to pursue bevacizumab combined with chemotherapeutics. He was charged home with abdominal pain relief and outpatient follow-up after short-course of chemotherapy.
Imaging of Diffuse B Cell Large Lymphoma in Liver, Kidneys, Pancreas and Myoc...semualkaira
A 41-year-old man was transferred to our Infectious Diseases Unit
with a history of three weeks of fever, abdominal pain, nausea,
vomiting and weight loss. He was HIV positive since 2013 but discontinued antiretroviral therapy in 2019. A
Imaging of Diffuse B Cell Large Lymphoma in Liver, Kidneys, Pancreas and Myoc...semualkaira
A 41-year-old man was transferred to our Infectious Diseases Unit
with a history of three weeks of fever, abdominal pain, nausea,
vomiting and weight loss. He was HIV positive since 2013 but discontinued antiretroviral therapy in 2019
Imaging of Diffuse B Cell Large Lymphoma in Liver, Kidneys, Pancreas and Myoc...semualkaira
A 41-year-old man was transferred to our Infectious Diseases Unit
with a history of three weeks of fever, abdominal pain, nausea,
vomiting and weight loss. He was HIV positive since 2013 but discontinued antiretroviral therapy in 2019. At admission he was afebrile, with haemoglobin level of 12.8 g/dL
Imaging of Diffuse B Cell Large Lymphoma in Liver, Kidneys, Pancreas and Myoc...semualkaira
A 41-year-old man was transferred to our Infectious Diseases Unit
with a history of three weeks of fever, abdominal pain, nausea,
vomiting and weight loss. He was HIV positive since 2013 but discontinued antiretroviral therapy in 2019.
Imaging of Diffuse B Cell Large Lymphoma in Liver, Kidneys, Pancreas and Myoc...semualkaira
A 41-year-old man was transferred to our Infectious Diseases Unit
with a history of three weeks of fever, abdominal pain, nausea,
vomiting and weight loss. He was HIV positive since 2013 but discontinued antiretroviral therapy in 2019
Imaging of Diffuse B Cell Large Lymphoma in Liver, Kidneys, Pancreas and Myoc...semualkaira
A 41-year-old man was transferred to our Infectious Diseases Unit
with a history of three weeks of fever, abdominal pain, nausea,
vomiting and weight loss. He was HIV positive since 2013 but discontinued antiretroviral therapy in 2019. At admission he was afebrile, with haemoglobin level of 12.8 g/dL, leucocytes 4,340 cells/
mm³, platelets 237,000 cells/mm³, reative C protein 14.1 mg/dL,
urea 48 mg/dL, creatinin 0.98 mg/dL, n
Imaging of Diffuse B Cell Large Lymphoma in Liver, Kidneys, Pancreas and Myoc...semualkaira
A 41-year-old man was transferred to our Infectious Diseases Unit
with a history of three weeks of fever, abdominal pain, nausea,
vomiting and weight loss. He was HIV positive since 2013 but discontinued antiretroviral therapy in 2019. At admission he was afebrile, with haemoglobin level of 12.8 g/dL, leucocytes 4,340 cells/
mm³, platelets 237,000 cells/mm³, reative C protein 14.1 mg/dL,
urea 48 mg/dL, creatinin 0.98 mg/dL, n
Imaging of Diffuse B Cell Large Lymphoma in Liver, Kidneys, Pancreas and Myoc...semualkaira
A 41-year-old man was transferred to our Infectious Diseases Unit
with a history of three weeks of fever, abdominal pain, nausea,
vomiting and weight loss. He was HIV positive since 2013 but discontinued antiretroviral therapy in 2019. At admission he was afebrile, with haemoglobin level of 12.8 g/dL
Deep Venous Thromboembolism in Gynecological Malignanciessemualkaira
Deep venous thrombosis is a severe complication often following
gynecological malignancy. It presents a main reason of post-operative complication, morbidity and mortality in these patients. It is
crucial to know risk factors and to diagnose possible early manifestations of the disease in time [1]. DVT is the second leading
cause of death in patients with gynecologic cancer and the risk of
DVT in women underwent gynecologic surgery ranged from 17%
to 40%, while the rate of pulmonary embolism (PE) was about 1%
to 26% [2].
Deep Venous Thromboembolism in Gynecological Malignanciessemualkaira
Deep venous thrombosis is a severe complication often following
gynecological malignancy. It presents a main reason of post-operative complication, morbidity and mortality in these patients. It is
crucial to know risk factors and to diagnose possible early manifestations of the disease in time [1]. DVT is the second leading
cause of death in patients with gynecologic cancer and the risk of
DVT in women underwent gynecologic surgery ranged from 17%
to 40%, while the rate of pulmonary embolism (PE) was about 1%
to 26% [2].
Deep Venous Thromboembolism in Gynecological Malignanciessemualkaira
Deep venous thrombosis is a severe complication often following
gynecological malignancy. It presents a main reason of post-operative complication, morbidity and mortality in these patients. It is
crucial to know risk factors and to diagnose possible early manifestations of the disease in time [1]. DVT is the second leading
cause of death in patients with gynecologic cancer and the risk of
DVT in women underwent gynecologic surgery ranged from 17%
to 40%, while the rate of pulmonary embolism (PE) was about 1%
to 26% [2].
Simple liver cysts are congenital or acquired benign cysts formations and are commonly found incidentally. It has a prevalence of 3-5% in ultrasound studies and 18-24% in CT scans. Frequently asymptomatic, liver cysts may be associated with symptoms in 10-16% of patients. Hemoperitoneum is a far rare complication. Herein, we report a case presented at the emergency room with acute hemorrhagic rupture of a liver cyst.
How to Make a Field invisible in Odoo 17Celine George
It is possible to hide or invisible some fields in odoo. Commonly using “invisible” attribute in the field definition to invisible the fields. This slide will show how to make a field invisible in odoo 17.
We all have good and bad thoughts from time to time and situation to situation. We are bombarded daily with spiraling thoughts(both negative and positive) creating all-consuming feel , making us difficult to manage with associated suffering. Good thoughts are like our Mob Signal (Positive thought) amidst noise(negative thought) in the atmosphere. Negative thoughts like noise outweigh positive thoughts. These thoughts often create unwanted confusion, trouble, stress and frustration in our mind as well as chaos in our physical world. Negative thoughts are also known as “distorted thinking”.
Instructions for Submissions thorugh G- Classroom.pptxJheel Barad
This presentation provides a briefing on how to upload submissions and documents in Google Classroom. It was prepared as part of an orientation for new Sainik School in-service teacher trainees. As a training officer, my goal is to ensure that you are comfortable and proficient with this essential tool for managing assignments and fostering student engagement.
Read| The latest issue of The Challenger is here! We are thrilled to announce that our school paper has qualified for the NATIONAL SCHOOLS PRESS CONFERENCE (NSPC) 2024. Thank you for your unwavering support and trust. Dive into the stories that made us stand out!
The French Revolution, which began in 1789, was a period of radical social and political upheaval in France. It marked the decline of absolute monarchies, the rise of secular and democratic republics, and the eventual rise of Napoleon Bonaparte. This revolutionary period is crucial in understanding the transition from feudalism to modernity in Europe.
For more information, visit-www.vavaclasses.com
Welcome to TechSoup New Member Orientation and Q&A (May 2024).pdfTechSoup
In this webinar you will learn how your organization can access TechSoup's wide variety of product discount and donation programs. From hardware to software, we'll give you a tour of the tools available to help your nonprofit with productivity, collaboration, financial management, donor tracking, security, and more.
Synthetic Fiber Construction in lab .pptxPavel ( NSTU)
Synthetic fiber production is a fascinating and complex field that blends chemistry, engineering, and environmental science. By understanding these aspects, students can gain a comprehensive view of synthetic fiber production, its impact on society and the environment, and the potential for future innovations. Synthetic fibers play a crucial role in modern society, impacting various aspects of daily life, industry, and the environment. ynthetic fibers are integral to modern life, offering a range of benefits from cost-effectiveness and versatility to innovative applications and performance characteristics. While they pose environmental challenges, ongoing research and development aim to create more sustainable and eco-friendly alternatives. Understanding the importance of synthetic fibers helps in appreciating their role in the economy, industry, and daily life, while also emphasizing the need for sustainable practices and innovation.
Operation “Blue Star” is the only event in the history of Independent India where the state went into war with its own people. Even after about 40 years it is not clear if it was culmination of states anger over people of the region, a political game of power or start of dictatorial chapter in the democratic setup.
The people of Punjab felt alienated from main stream due to denial of their just demands during a long democratic struggle since independence. As it happen all over the word, it led to militant struggle with great loss of lives of military, police and civilian personnel. Killing of Indira Gandhi and massacre of innocent Sikhs in Delhi and other India cities was also associated with this movement.
2. 2 Case Reports in Hematology
(a) (b)
Figure 1: 200x (a) and 500x oil (b) poweredperipheral blood smear demonstrating numerous circulating blasts (81%) without Auer rods
(black arrow) consistent with acute myeloid leukemia.
(a) (b)
Figure 2: Chest X-ray (a) and computed tomography (b) demonstrating bilateral pulmonary infiltrates.
appendicitis with retroperitoneal and mesenteric lymph
nodes.
On presentation, the patient’s abdominal pain was con-
cerning for acute appendicitis and leukemoid reaction versus
ischemic bowel. Given the patients anemia, leukocytosis, and
thrombocytopenia, an underlying hematologic malignancy
leading to hyperviscosity remained likely. Her chest X-ray
and CT of the chest which demonstrated patchy bilateral
ground-glass densities (Figure 2) were concerning for a
bilateral pneumonia versus infiltrates secondary to congestive
heart failure or leukemic infiltrates.
Within hours of arrival, the patient was taken to the
operating room and underwent laparoscopic appendectomy.
The surgical specimen of the appendix on macroscopic
review showed a tan-brown serosa with areas of hemorrhage
and the lumen containing fecal material without evidence of
abscess. On microscopic review the appendix revealed diffuse
infiltrate of atypical larger cells consistent with blasts within
the wall of the appendix (Figure 3).
Following appendectomy, she was immediately trans-
ferred to the bone marrow transplant service. She underwent
unilateral bone marrow biopsy which showed FLT3-ITD- and
NPM1-mutated AML with hypercellular marrow consisting
of 80–90% blasts (Figure 4). Cytogenetic testing was nega-
tive for AML-associated gene rearrangements. According to
WHO classification, she was found to have AML with recur-
rent genetic abnormalities, specifically AML with mutated
NPM1.
Chemotherapy was initially delayed for one week to
allow for adequate wound healing postoperatively. During
the hospital course, she developed acute hypoxia. While
she was initially treated with a course of antibiotics for
presumed community acquired pneumonia, she failed to
improve symptomatically. After several days of monitoring
without response to therapy, her respiratory failure was
attributed to probable leukemic infiltration of the lung; subse-
quently leukapheresis and hydroxyurea were initiated. Her
respiratory status improved with high-dose steroids and
3. Case Reports in Hematology 3
(a)
(b) (c)
(d) (e)
Figure 3: (a) 20x cross-section of the appendix specimen. (b) 100x powered and (c) 200x powered appendiceal wall demonstrating transmural
blastic infiltrates. (d) 100x powered and (e) 200x powered cross-section of appendix demonstrating leukemic infiltrates.
initiation of chemotherapy with idarubicin and cytarabine
(7 + 3).
Her fourteen-day bone marrow biopsy was deferred
secondary to sepsis and a decline in her performance status
as demonstrated by a change in the ECOG score from 0 on
admission to 3 at the time of expected repeat biopsy. She
underwent a 30-day bone marrow biopsy which showed 50–
60% hypercellularity and no evidence of disease recurrence.
She was released from the hospital after approximately one
month with her AML in remission (CR1). She returned within
two months with confirmed relapsed AML on bone marrow
biopsy. The patient started reinduction chemotherapy on trial
comparing cytarabine/vosaroxin versus cytarabine/placebo.
Following one cycle of therapy, her performance status had
declined and she was no longer a candidate for additional
therapy. The patient was discharged home with hospice
support and expired 185 days after initial presentation.
3. Discussion
Leukemic infiltration has previously been documented in
multiple organ systems. Wandroo et al. presented infiltrates
4. 4 Case Reports in Hematology
(a) (b)
Figure 4: 100x (a) and 200x (b) powered core bone marrow biopsy demonstrating hypercellular marrow (approximately 40–80% cellularity)
with interstitial blast infiltrate (80–90% of cellularity by morphology).
leading to cholestatic hepatitis [6]. Leukemic infiltration of
the bowel [4, 7] and pulmonary infiltration have frequently
been described [1, 8, 9]. In the setting of known AML,
the differential for acute abdominal pain typically includes
acute appendicitis versus typhlitis. Prior case reports typi-
cally describe patients receiving chemotherapy who develop
abdominal pain and are found to have suppurative appen-
dicitis with surgical intervention [2, 5]. Of the limited cases
described of acute appendicitis in patients with leukemia, less
than 10 patients were noted to have nonsuppurative leukemic
infiltration of the appendix proven on pathological review
[2, 7, 10, 11]. The four cases described by Prolla all died within
days and autopsies revealed hemorrhagic appendicitis. The
average time to morbidity in the cases with demonstrated
infiltrate was approximately 32.6 days. Acute appendicitis as
the initial manifestation of AML, as in this case, has only been
described in two other cases where the patients were found to
have AML M3 and FAB M2 AML with a survival time of 30
days and 49 days, respectively [10, 11].
We report a rare case of AML presenting as acute
nonsuppurative appendicitis with leukemic cell infiltration.
While the associated morbidity of appendicitis and leukemia
is high, this patient benefited from the prompt treatment
with appendectomy and early initiation of chemotherapy.
Compared to prior case reports with a mean survival of
32.6 days, our patient’s length of survival was considerably
longer at 185 days. This case illustrates the importance of
maintaining a high suspicion for acute leukemia in the setting
of a significant leukemoid reaction even if a clear acute
process such as appendicitis is present.
References
[1] A. M. Huq, E. L. Flenaugh, and M. Nichols, “Hemoptysis,
anemia and respiratory failure: a rare initial presentation of
acute leukemia,” Journal of the National Medical Association, vol.
97, no. 11, pp. 1550–1552, 2005.
[2] P.-J. Hsiao, S.-M. Kuo, J.-H. Chen et al., “Acute myelogenous
leukemia and acute leukemic appendicitis: a case report,” World
Journal of Gastroenterology, vol. 15, no. 44, pp. 5624–5625, 2009.
[3] H. Rappaport, “Tumors of the hematopoietic system,” in Atlas
of Tumor Pathology, section 3, fascicle 8, pp. 241–247, Armed
Forces Institute of Pathology, Washington, DC, USA, 1967.
[4] D. Antic, I. Elezovic, A. Bogdanovic et al., “Isolated myeloid
sarcoma of the gastrointestinal tract,” Internal Medicine, vol. 49,
no. 9, pp. 853–856, 2010.
[5] K. U. Kim, J. K. Kim, J. H. Won, D. S. Hong, and H. S. Park,
“Acute appendicitis in patients with acute leukemia,” Korean
Journal of Internal Medicine, vol. 8, no. 1, pp. 40–45, 1993.
[6] F. A. Wandroo, J. Murray, D. Mutimer, and S. Hubscher, “Acute
myeloid leukaemia presenting as cholestatic hepatitis,” Journal
of Clinical Pathology, vol. 57, no. 5, pp. 544–545, 2004.
[7] J. C. Prolla and J. B. Kirsner, “The Gastrointestinal Lesions and
Complications of the Leukemias,” Annals of Internal Medicine,
vol. 61, pp. 1084–1103, 1964.
[8] P.-H. Huang, J.-Y. You, and H.-C. Hsu, “Extensive pulmonary
infiltration by leukemic blasts successfully treated with hydrox-
yurea: a case report,” Haematologia, vol. 32, no. 1, pp. 87–91,
2002.
[9] L. E. Heyneman, T. Johkoh, S. Ward, O. Honda, S. Yoshida, and
N. L. M¨ullern, “Pulmonary leukemic infiltrates: high-resolution
CT findings in 10 patients,” American Journal of Roentgenology,
vol. 174, no. 2, pp. 517–521, 2000.
[10] G. M¨uller, J. L. Dargent, V. Duwel et al., “Leukaemia and
lymphoma of the appendix presenting as acute appendicitis
or acute abdomen. Four case reports with a review of the
literature,” Journal of Cancer Research and Clinical Oncology,
vol. 123, no. 10, pp. 560–564, 1997.
[11] T. Toubai, Y. Kondo, T. Ogawa et al., “A case of leukemia of the
appendix presenting as acute appendicitis,” Acta Haematologica,
vol. 109, no. 4, pp. 199–201, 2003.
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