Childhood leukemic hyperleukocytosis poses a serious threat to life because of its associated metabolic complications. The present prospective trial utilized conservative management of childhood acute lymphoblastic leukemia with hyperleukocytosis (total white cell count equal or > 100 x 10(9)/L) by intravenous hydration, urinary alkalinization, and allopurinol presenting without severe life-threatening complications. The median reduction in WBC count was 81.51% (range: 66-98.8%) within a median period of 36 hours (range: 12-60 hours) following hospitalization. There were no failures or treatment related complications. Thus we conclude that in childhood acute lymphoblastic leukemia, hyperleukocytosis can be managed safely and effectively with intravenous hydration, urinary alkalinization, and allopurinol before starting any specific anti-leukemic chemotherapy avoiding risk-associated cranial irradiation, leukapheresis, and exchange transfusion.
A 24-year-old male, presented to the oncology outpatient department of Saifee hospital with the complaints of abdominal distention, pain and significant weight loss since 2 months. Clinical examination revealed a mass in the left inferior quadrant of abdomen and lumbar region.Multiple Detector Computed Tomography (MD-CT) of abdomen [Table/ Fig-1] revealed a large heterogeneously enhancing mass in the left half of abdomen measuring 16 x 12 x 18.8 cm in dimensions, and extending from left hypochondrium to the lower lumbar region displacing the kidney. A 99mTc-HYNIC TOC scan [Table/ Fig-2] revealed a heterogeneous mass with diffusely increased tracer uptake along with a small focus of increased uptake in the left supraclavicular region suggestive of solitary metastatic disease.
Desmoplastic small round cell tumor (RCT) is a relatively newly recognized neoplasm. It has a very distinct morphologic and high-grade polyphenotypic expression with a very poor prognosis. It is commonly seen in adolescent boys. We describe two cases of intra-abdominal desmoplastic small RCT in young girls (5 and 11 years of age). In both cases, the exact origin of tumor in the abdomen could not be established. Histopathologic examination of the biopsy specimens showed distinct desmoplastic stroma and coexpression of various epithelial, neural, and muscle markers. These two patients were treated primarily by debulking surgery followed by adjuvant chemotherapy (RCT II protocol). One of the two had a stable disease while the other had a progressive disease while on treatment. Thus our findings support the diverse histogenesis of this tumor and its poor prognosis.
Successful autologous bone marrow transplantation (ABMT) and peripheral blood stem cell transplantation depend on safe hematopoietic stem cell (HSC) cryopreservation and storage. Several successful methods for cryopreservation and storage have been established and are commonly used all over the world. However, little is known about the effects of long-term cryopreservation on the capacity to sustain a complete immunohematopoietic engraftment. Several authors have investigated stem cell viability after cryopreservation and storage for more than 5 years and reported preclinical good viabilities in terms of dye-exclusion or colony-forming capability in vitro. Only two studies using BM cryopreserved for more than 5 years for transplantation are reported, but they did not provide proof of trilineage engraftment. In February 1997 at our institution, a patient with relapsed non-Hodgkin's lymphoma underwent ABMT with BM harvested in February 1990. He achieved a granulocyte count > 500 x 10(6)/L on day 21 and a self-supporting platelet count > 20 x 10(9)/L on day 30. After day 29, his hemoglobin level was satisfactory without need of transfusion support. This successful trilineage engraftment with cryopreserved BM that had been stored for 7 years suggests that HSC are able to maintain their capability to reconstitute hematopoiesis for a long time.
Background: Following to approval of Pembrolizumab for patients with advanced NSCLC, PD-L1 IHC 22C3 pharmDx (Dako) was adopted as a companion diagnostic test. While PD-L1 IHC 28-8 pharmDx (Dako) was established as a complementary diagnostic for Nivolumab. Recently many groups demonstrated the intra-tumor heterogeneity of these PD-L1 expressions, but there have been a few reports about the intra-patient or inter-tumor heterogeneity. We aimed to investigate the inter-tumor heterogeneity of PD-L1 IHC 22C3 and 28-8 pharmDx (Dako). Method: Between December 1, 2014 and May 7, 2018, total 517 patients with NSCLC underwent surgical resection at our hospital. We excluded all patients with no informed consent, with no lymph node metastasis, with chemotherapy/radiotherapy before surgery and with never enough volume of material for genetic testing. Finally, 35 formalin-fixed paraffin-embedded primary tumors with paired metastatic lymph nodes were available in this study. After staining by PD-L1 IHC 22C3 and 28-8 pharmDx (Dako) respectively, we counted tumor cells exhibiting membrane staining and calculated Tumor Proportion Score (TPS). Afterward, all cases were classified into three subgroups as follows; No Expression (TPS: <1%), Low Expression (TPS: 1-49%) and High Expression (TPS: 50%). Result: Average age of 35 patients was 66.8 years old and there were 10 females (28.6%), 10 never smokers (28.6%), 27 adenocarcinomas (77.1%) and 11 tumors with EGFR mutation. The number of cases in No Expression, Low Expression and High Expression in 22C3 were 7 (20.0%), 22 (62.8%) and 6 (17.1%) in primary tumor, meanwhile 18 (51.4%), 13 (37.1%) and 4 (11.4%) in metastatic lymph node, respectively. The concordant rate was 28.6% between TPS subgroups in primary tumor and that in metastatic lymph node. About 28-8 antibody, No Expression, Low Expression and High Expression were 8 (22.9%), 21 (60.0%) and 6 (17.1%) in primary tumor, meanwhile 18 (51.4%), 11 (31.4%) and 6 (17.1%) in metastatic lymph node, respectively. The concordant rate was 31.4% between TPS subgroups in primary tumor and that in metastatic lymph node. Conclusion: Our result demonstrated apparent discrepancy of TPS between primary tumor and metastatic lymph node in both PD-L1 IHC 22C3 and 28-8.
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