Introduction Tyrosine kinase inhibitors have become the mainstay of treatment for many malignancies, but their use can be accompanied by unusual and often puzzling side effects. Case report We describe herein a 64-year-old patient who developed a robust and sustained erythrocytosis shortly after starting treatment with lenvatinib. Our patient also experienced elevated blood pressure, mucositis, and hand-foot syndrome that are not uncommonly seen with this agent. The clinico-laboratory work-up suggested that lenvatinib was the likely culprit in this case. Management & Outcome Lenvatinib had to be discontinued due to suboptimal tolerance and a short-lived response. With the discontinuation of lenvatinib, hemoglobin trended downwards and subsequently resolved. A score of 6 on the Naranjo nomogram supported a probable causality relationship between lenvatinib and the observed erythrocytosis. Discussion Erythrocytosis has previously been described with sunitinub, sorafenib and pazopanib. The exact mechanism of this phenomenon is not known. It might increase the risk of venous and arterial thromboses in cancer patients that are already in a hypercoagulable state due to cancer itself. In addition, laboratory work-up for polycythemia may prove extensive and costly. Therefore, clinicians need to be aware of this important side effect of tyrosine kinase inhibitors.
e18104 Background: Papillary serous uterine cancer (PSUC) is a rare, clinically aggressive histotype accounting for 40% of uterine cancer deaths. Clinicopathologic characteristics and outcomes between older and younger PSUC patients may differ. Methods: With IRB approval, we conducted a retrospective analysis of 554 consecutive patients with uterine cancer treated at our institution from 2009-19. Consistent with findings from the SEER database, 28 patients (5%) had PSUC. Most PSUC patients were Caucasian; Latinas comprised 14.2%. Thirteen patients were seventy years of age or younger (≤70) and fifteen were older than seventy ( > 70). Clinicopathologic features, therapy and survival were compared between two cohorts. Statistical analysis: Significance of associations was assessed with Fishers' exact test. Survival analysis was performed with Cox proportional model with censoring to calculate hazard ratios (HR). Results: The two cohorts were well-balanced for stage (TNM stages I+II vs. TNM stages III+IV). More than 90% of patients in each group had surgical excision/debulking, and nearly half of patients in each group received systemic chemotherapy. The most frequently used chemotherapy regimen was carboplatin-paclitaxel. Compared to patients ≤70, patients > 70 were less likely to undergo postoperative radiation therapy (6% vs 61.5%; p = 0.001). Cancer-specific survival (CSS) was worse in patients > 70 as opposed to patients ≤70 (21.8 vs. 27.4 months; HR 0.61, p = 0.03). Four PSUC patients > 70 had a personal history of metachronous breast cancer; none ≤70 had a history of breast cancer. We identified five cases of breast cancer, two cases of colon cancer, and one case each of ovarian and uterine cancer in first-degree relatives of PSUC patients > 70. Conclusions: Older PSUC patients displayed significantly shorter CSS than their younger counterparts. They were also less likely to receive radiation therapy. As personal and family history of older PCUS patients identified an excess of other cancers, comprehensive germline mutation testing may be warranted. Final statistical analysis, comparison to SEER data and significance will be presented.
Introduction Autoimmune disorders, including autoimmune cytopenias, are more common in patients with myelodysplastic syndrome (MDS) and may share with MDS the same steps of pathogenesis. Some patients with MDS have antibodies against red cells. Case report We describe herein a 79-year-old patient who presented with fatigue, jaundice and pancytopenia. She was diagnosed with warm-antibody autoimmune hemolytic anemia (AIHA) and synchronous MDS. Management and outcome: In our patient, AIHA responded to the hypomethylating agent 5-azacitidine used for the treatment of MDS. Six months later, the patient remains in clinico-laboratory remission for both MDS and AIHA. Discussion/conclusions Our case indirectly suggests that 5-azacitidine led to a decrease in autoantibody production by the auto-reactive B-cell clone in MDS leading in turn to a diminished rate of autoimmune hemolysis. If our observation is accurate, we believe that similar reports will populate the scientific literature in the future years.
e20040 Background: Monoclonal gammopathy of undetermined significance (MGUS) can be associated with significant neurologic morbidity. Of non-IgM MGUS, types IgG and IgA are most commonly associated with peripheral neuropathy (PN). Methods: With IRB approval, we conducted a retrospective cohort study of consecutive patients with non-IgM type MGUS treated at our institution from 2014-2021. Other conditions potentially causing PN were excluded. Statistical analysis: Descriptive statistics were calculated to characterize the study population, and Relative Risk (RR) of PN was evaluated for selected patient, and disease, related factors. P < 0.05 was defined as statistically significant. Results: During the study period, 94 patients with non-IgM type MGUS were seen and comprised the study population. Twenty-two (23.4%) had evidence of PN. Median age was 74; 82% (18/22 ) were Caucasian; 73% (16/22) were women. 82% (18/22) patients had MGUS type IgG kappa or IgA kappa. We identified only 2 patients with each MGUS kappa light chain (LC) and MGUS IgG lambda. Median M-protein size was 0.11 g/dL, and median free LC value was 6.84 mg/L. Incidence/severity of kidney disease was similar in non-IgM MGUS patients with and without PN (p > 0.05). RR of PN was not found to be significantly different based on race or gender, although there appeared to be a tendency for women to be at higher risk compared to men (RR = 1.98, 95% CI = 0.85 to 4.60, p = 0.114.) Kappa LC restriction was strongly associated with PN (RR = 4.31, 95% CI = 1.58 to 11.78; p = 0.004). Electromyographic (EMG) studies identified 14 patients (64%) with distal symmetric axonal neuropathy (DSAN) and 8 patients (36%) with chronic inflammatory demyelinating polyneuropathy (CIDP). Clinically severe PN was identified in 11 (50%) patients; all were subsequently treated with IVIg therapy. Only 5/11 (45%) patients responded to IVIg, and the responses were only partial and transient. Conclusions: This is the first report, to our knowledge, of a significant association of kappa (as opposed to lambda) LC restriction with PN among patients with non-IgM type MGUS. Further investigation is warranted to explain this finding, elucidate pathophysiology and aid in developing more effective therapeutic options. Pending mechanistic characterization of this association, trials of contemporary agents used to treat other plasma cell disorders may be in order. Final statistical analysis, comparison to published series and significance will be presented.
Conclusion: The suspicion of hepatic cystadenoma is fundamental in the therapeutic, are infrequent tumors less than 5%, and its malignant potential makes this surgery indicated. Normality in tumor markers such as CA19-9 and carcinoembryonic antigen does not exclude the diagnosis. Rule out differential diagnoses as in our first case, hepatic echinococcosis. Major hepatectomies or lobectomies should be taken into consideration depending on the tumor location and resulting hepatic reserve. Not indicating another type of minor surgical treatment, such as drainage or unroofing of the lesion, due to the high probability of recurrence or to that it is a malignant lesion after the complete histological study of the piece.
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