Diffuse large B-cell lymphoma (DLBCL) can arise in both lymph nodes and extranodal sites. DLBCLs rarely present in the soft tissue of the upper extremity. We report a case of a 64-year-old woman who presented with a large left upper arm mass and underwent surgical resection under the presumptive diagnosis of sarcoma but the final pathology showed DLBCL. Sarcomas are common malignant tumors of the soft tissue of the extremities, but lymphomas also occasionally present as a soft tissue mass. It is important to keep lymphomas in mind in order to avoid unnecessary surgical excisions.
Acute multiorgan failure syndrome (MOFS) remains a significant cause of mortality in sickle cell disease (SCD) patients despite red cell exchange (RCE). In small case series and reports, therapeutic plasma exchange (TPE) has shown benefit in MOFS. As further support for consideration of this modality, we present two patients with SCD and MOFS refractory to RCE who were subsequently treated with TPE. Fresh frozen plasma was used as the replacement fluid. Despite estimated hospital mortality of 40% at the time of intensive care unit admission, both patients showed marked clinical improvement with TPE treatment. Our cases add to the evidence supporting the potential inclusion of MOFS secondary to acute SCD as an indication for TPE in the next edition of the American Society of Apheresis Guidelines on the Use of Therapeutic Apheresis in Clinical Practice.
Background: Nonpuerperal ovarian vein thrombosis (OVT) is a rare clinical entity. Therapy is not well defined. OVT is usually asymptomatic. Improved CT and MR imaging technology enables OVT to be diagnosed with greater frequency. Nonpuerperal OVT may be a distinct clinical entity. Methods: The medical records of women with nonpuerperal OVT were reviewed and their clinical course and treatment recorded. Cases were identified by scanning a CT computerized database over the past 3 years with the key words ovarian vein thrombosis. Results: 7 patients (pts) were identified. Age range was 38–61, median 51 years. 3 pts had OVT on the left and 4 on the right. OVT followed a procedure in 2 pts. 2 pts with breast cancer developed OVT, 1 during adjuvant tamoxifen and 1 receiving chemotherapy for metastatic disease. 1 pt had AML in CR. 3 pts presented with lower abdominal pain on the involved side and 1 pt had lower abdominal pain on the opposite side. The 3 pts with cancer were asymptomatic. 4 pts had uterine fibroids. 1 developed OVT in the setting of an acute diarrheal illness. 1 pt had prior DVT and 1 a family history of DVT. Only 1 pt had a hypercoagulable evaluation; negative. 2 pts had clot extending to the junction with the inferior vena cava (IVC) and both were anticoagulated with enoxaparin followed by warfarin. 1 pt was anticoagulated with enoxaparin alone. No embolic complications occurred. Conclusion: 4 pts with OVT were symptomatic and 3 were detected incidentally. 2 developed OVT following procedures, 3 had predisposing underlying conditions, and 2 had a personal or family history of thrombosis. Optimum therapy is not defined. Symptomatic disease alone is not an indication for anticoagulation. Anticoagulation may be indicated if clot extends to the IVC.
We report a unique case of lung cancer involving two different histologic variants. Mucoepidermoid carcinoma (MEC) a salivary gland-type tumor and conventional adenocarcinoma CASE PRESENTATION: The patient in this case study is a 57-year-old male non-smoker with history of hypertension, prostate cancer and deep venous thrombosis, who was incidentally found to have chest x-ray findings concerning for diaphragmatic eventration. Computed tomography (CT) of the chest revealed a linear area of scarring in the left upper lobe and a 5 mm nodule in the left lower lobe (Figure 1, 2). Positron emission tomography-CT (PET-CT) was obtained to evaluate the nodule which revealed a metabolically active 2.8 x 1.5 cm opacity in the left upper lobe, suspicious for malignancy (Figure 3). He underwent CT guided biopsy of the left upper lobe nodule. After the diagnosis, he underwent left Video-Assisted Thoracic Surgery which converted into an open thoracotomy with left upper lobe lobectomy. Microscopic examination revealed that the tumor was located in the peribronchial area of the lung and compromised of two different histologic components: A central MEC component, containing mucin producing cells. The MEC part was negative for cytokeratin 7 (CK7), thyroid transcription factor-1 (TTF-1) and Napsin. The central MEC part of the tumor is surrounded by adenocarcinoma component. The adenocarcinoma component presented with mixed lepidic and acinar patterns positive for TTF-1, Napsin and CK7 but negative for P63 and P40 stains. According to the seventh edition of TNM staging for lung tumors, the clinical stage of this patient was pT2aNO Stage IV.DISCUSSION: Salivary gland-type lung cancers are relatively rare neoplasms of the lung. They represent about 0.1 to 0.2% of primary lung tumors and are detected incidentally. CT findings usually include a well-defined endobronchial mass with or without obstructive pneumonia or atelectasis (1). The genetic analysis of cancer cells is the standard of care in order to select the most effective therapy; however, the genetic characteristics of MEC are not yet fully understood. Mutations in EGFR and ALK genes are routinely tested to identify lung adenocarcinoma patients who could benefit from treatment with target therapies. Treatment of choice is complete surgical excision as its controversial if pulmonary MEC is responsive to chemotherapy and radiotherapy; however, in cases of high-grade PMEC, adjuvant chemotherapy has been reserved when complete resection is impossible. Patients with unresectable disease have responded to EGFR-targeted therapy.CONCLUSIONS: This case report serves to illustrate the rare combination of MEC and adenocarcinoma. Early surgical intervention has shown to be favorable in low-grade MEC; however, further investigation is required to evaluate for the need for adjunct therapy in the future given the risks of developing high-grade MEC and adenocarcinoma.
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