Background. Multiple articles discuss the rare incidence and potential causes of second hematologic disorders arising after treatment of Chronic Myelogenous Leukemia (CML), leading to the theory of imatinib, the current treatment regimen for CML, as a possible trigger for the development of secondary neoplasms. Our case eliminates the possibility of imatinib as the sole cause since our patient received a diagnosis of simultaneous plasma cell myeloma, CML, and a Jak2 mutation positive myeloproliferative disorder (MPD) arising de novo, prior to any treatment. We will further investigate into alternative theories as potential causes for multiple hematopathologic disorders. Case Report. There are currently no reported cases with the diagnosis of simultaneous plasma cell myeloma, chronic myelogenous leukemia, and Jak2 positive myeloproliferative disorder. We present a case of a 77-year-old male who was discovered to have these three concurring hematopathologic diagnoses. Our review of the literature includes a look at potential associations linking the three coexisting hematologic entities. Conclusion. The mechanism resulting in simultaneous malignancies is most likely multifactorial and potentially includes factors specific to the host, continuous stimulation of the immune system, previous chemotherapy or radiation, a potential common pluripotent stem cell, or, lastly, preexisting myeloma which may increase the susceptibility of additional malignancies.
Over the last 50 years, a number of important physiological changes in humans who have traveled on spaceflights have been catalogued. Of major concern are the short-and long-term radiationinduced injuries to the hematopoietic system that may be induced by high-energy galactic cosmic rays encountered on interplanetary space missions. To collect data on the effects of space radiation on the human hematopoietic system in vivo, we used a humanized mouse model. In this study, we irradiated humanized mice with 0.4 Gy of 350 MeV/n 28 Si ions, a dose that has been shown to induce tumors in tumor-prone mice and a reference dose that has a relative biological effectiveness of 1 (1 Gy of 250-kVp X rays). Cell counts, cell subset frequency and cytogenetic data were collected from bone marrow spleen and blood of irradiated and control mice at short-term (7, 30 and 60 days) and long-term (6-7 months) time points postirradiation. The data show a significant short-term effect on the human hematopoietic stem cell counts imparted by both high-and low-LET radiation exposure. The radiation effects on bone marrow, spleen and blood human cell counts and human cell subset frequency were complex but did not alter the functions of the hematopoietic system. The long-term data acquired from high-LET irradiated mice showed complete recovery of the human hematopoietic system in all hematopoietic compartments. The combined results demonstrate that, in spite of early perturbation, the longer term effects of high-LET radiation are not detrimental to human hematopoiesis in our system of study.
IntroductionCurrently, molecular studies are widely used as a guiding tool in further management of cytologically indeterminate thyroid nodules. At our institution, clinicians have recently expressed concern over receiving “less positive molecular results” upon switching from an extended 14 gene mutation panel (EGMP) to a 7 gene mutation panel (GMP). Our goal is to compare outcomes of these two tests in regards to the performance characteristics and clinical impact.Materials and MethodsAll thyroid fine‐needle aspiration (FNA) biopsy specimens sent for molecular studies from 2016 to 2017 were retrospectively studied. Cytopathology diagnosis, pertinent clinical findings, molecular results, and follow‐up (F/U) surgical and cytology diagnoses were recorded.ResultsOf the total 165 cases sent for molecular tests 86 (52%) were GMP and 79 (47%) EGMP. There were 21 (24%) and 40 (50%) cases with positive GMP and EGMP results, respectively. Within these positive cases (n = 61), there were a total of 33 (54%) patients who underwent surgical resection and 28 (45%) patients had no follow‐up. The molecular findings and surgical pathologic diagnoses obtained are illustrated in Figures 1 through 4 for GMP and EGMP, respectively.ConclusionsThe selection of molecular testing should be directed toward optimizing patient care and facilitate clinical management. This quality assurance study helped in understanding the complexities associated with test selection best suited for our institution and in educating clinicians.
Pap smears with NTZ were not at a higher risk for subsequent detection of cervical abnormalities, making earlier repeat testing unnecessary. Rescreening cases without TZ is neither cost effective nor necessary.
Background: Coexistence of Chronic lymphocytic lymphoma (CLL) to Acute lymphoblastic leukemia is extremely rare with only a few reported cases [1-5]. Chronic lymphocytic leukemia is a neoplasm of small monomorphic round to irregularly shaped lymphocytes of B-cell lineage. Adverse prognostic factors in CLL include flow cytometric expression of ZAP-70 and CD38 which are surrogate markers for the mutational status of IVIg. T-cell acute lymphoblastic leukemia (T-ALL) is a neoplasm of lymphoblasts that are of T-cell lineage and are small to medium-sized cells. Case Report: We present a case of a 62-year-old man, diagnosed with B-Chronic Lymphocytic Leukemia who was treated successfully twice. A year following an allogeneic stem cell transplantation (SCT), the CLL returned for a third time along with a secondary diagnosis of T-cell acute lymphoblastic leukemia. Our review of literature explores the potential pathophysiologic mechanisms of the coexistence of these two diagnoses. Conclusion: Chronic lymphocytic leukemia has been known to evolve into various lymphoid transformations, including diffuse large b-cell lymphoma, and prolymphocytic leukemia, however the coexistence and transformation of CLL to T-cell acute lymphoblastic lymphoma is extremely rare. Potential mechanisms of this phenomemon may include a common genetic predisposition, a malignant transformation of a common progenitor cell, immune deregulation, chronic stimulation of T-cells by the B-CLL cells, adverse effects of chemotherapy exposure, increased T-cell resistance to apoptosis, or to the slight occurrence of pure chance. Numerous hypotheses exist, however the precise relation of the two entities coexisting is unknown due to limited research and only a few known cases.
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