Our results show that Glut-1 is significantly associated with BLBC and might be a potential therapeutic target for this aggressive subgroup of breast cancer, and this warrants further investigations.
A n 88-year-old African American man was evaluated for altered mental status and was found to have a urinary tract infection. He developed septic shock with a positive blood culture for Escherichia coli, confirmed as extended spectrum beta-lactamase. During the course of infection, the aspartate aminotransferase and alanine aminotransferase increased rapidly from 50 U/L and 22 U/L to 348 U/L and 116 U/L, respectively. The bilirubin increased from 3.4 mg/dL to 4.4 mg/dL (direct: 3.2 mg/dL) with increased international normalized ratio, prolonged prothrombin time and activated partial thromboplastin time, and elevated creatinine. The peripheral blood smear showed normocytic normochromic anemia with acanthocytes and neutrophilic leukocytosis (white blood cells: 21.8 3 10 9 /L). Variable-sized, ill-defined, bright-green cytoplasmic inclusions (panels A and B) were seen in a subset of the patient's neutrophils (15% of total neutrophils). Associated reactive changes, including toxic granulation, cytoplasmic vacuoles, and Döhle bodies, were noted in some of these neutrophils, as well as others. The green inclusions were negative for iron, myeloperoxidase, and bilirubin special stains. The platelets were 117 3 10 9 /L with normal morphology. The patient's condition deteriorated rapidly, and he expired 2 days after admission. Similar neutrophilic inclusions have been reported (Harris VN, Malysz J, Smith MD. Green neutrophilic inclusions in liver disease. J Clin Pathol. 2009;62[9]:853-854) in 2 patients with fatal acute hepatic failure just prior to death; we support the suggestion in this report that the presence of such inclusions may serve as a prognostic indicator of impending death.For additional images, visit the ASH IMAGE BANK, a reference and teaching tool that is continually updated with new atlas and case study images. For more information visit http://imagebank.hematology.org.
Adrenocortical carcinoma (ACC) is a rare endocrine malignancy that is usually large (>5 cm) at time of diagnosis. Delayed diagnosis significantly worsens survival. We describe adrenal gland morphology prior to ACC diagnosis and discern potential causes of delayed diagnosis. ACC patients seen at The University of Texas MD Anderson Cancer Center between 1998 and 2014 who had cross-sectional body imaging ≥3 months prior to their diagnosis. We conducted a detailed review of clinical and radiological features in these patients prior to ACC diagnosis. Of 439 patients with ACC, 25 had imaging preceding ACC diagnosis (5 with normal adrenal glands and 20 with preexisting masses). On the first available images, the median mass size was 2.8 cm (range 0-9) with median precontrast density of 36 Hounsfield units (range 17-43) and became 9 cm (range 1-18) at the time of ACC diagnosis. The median interval between first available image and ACC diagnosis was 20 months (range 3-89). In the 5 patients whose initial images showed normal adrenal glands, the time between the last normal scan and ACC diagnosis ranged from 5 to 36 months. The most common reason for delayed ACC diagnosis was the presumed benign status of the preexisting mass (n = 13, 65 %). Radiologically suspicious adrenal masses can precede ACC diagnosis and have variable growth patterns. ACC can also develop de novo within a few months in a radiologically documented normal adrenal gland. The presumed benignancy of preexisting masses based on size is the main reason for delayed ACC diagnosis.
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