Acute hepatitis-like presentation with cholestasis of CBFB-MYH11-positive acute myeloid leukemia in an adult male: a case report.

BACKGROUND: Liver involvement in adults with acute myeloid leukemia is uncommon. Most of the case reports describe acute liver failure or obstructive jaundice, while acute hepatitis is rarely mentioned. We report a patient with acute myeloid leukemia who presented with clinical, biochemical, and radiological signs of acute hepatitis that totally regressed after chemotherapy. CASE PRESENTATION: A 38-year-old Caucasian man presented with fever, cough, and mild fatigue. Laboratory workup showed anemia, thrombocytopenia, severe leukocytosis, transaminitis, and hyperbilirubinemia. Imaging of the abdomen (ultrasound and magnetic resonance) showed hepatomegaly, splenomegaly, upper limits portal veins diameters, increased thickness of the gallbladder wall, and significant abdominal lymph nodes. Peripheral blood smear and bone marrow evaluation were consistent with acute myeloid leukemia, and liver biopsy showed massive sinusoidal and portal infiltration by leukemic cells. After remission-inducing chemotherapy, there was complete normalization of liver function tests, and liver, spleen, and portal vein size. CONCLUSIONS: This case highlights the importance of taking acute myeloid leukemia into account as a possible cause of liver damage to make a rapid diagnosis and start appropriate treatment that may lead to hematological remission and hepatic dysfunction resolution.

Chemotherapy for Hepatocellular Carcinoma: Current Evidence and Future Perspectives.

Hepatocarcinogenesis is a multistep process, heralded by abnormalities in cell differentiation and proliferation and sustained by an aberrant neoangiogenesis. Understanding the underlying molecular pathogenesis leading to hepatocellular carcinoma is a prerequisite to develop new drugs that will hamper or block the steps of these pathways. As hepatocellular carcinoma has higher arterial vascularization than normal liver, this could be a good target for novel molecular therapies. Introduction of the antiangiogenic drug sorafenib into clinical practice since 2008 has led to new perspectives in the management of this tumor. The importance of this drug lies not only in the modest gain of patients' survival, but in having opened a roadmap towards the development of new molecules and targets. Unfortunately, after the introduction of sorafenib, during the last years, a wide number of clinical trials on antiangiogenic therapies failed in achieving significant results. However, many of these trials are still ongoing and promise to improve overall survival and progression-free survival. A recent clinical trial has proven regorafenib effective in patients showing tumor progression under sorafenib, thus opening new interesting therapeutic perspectives. Many other expectations have been borne from the discovery of the immune checkpoint blockade, already known in other solid malignancies. Furthermore, a potential role in hepatocellular carcinoma therapy may derive from the use of branched-chain amino acids and of nutritional support. This review analyses the biomolecular pathways of hepatocellular carcinoma and the ongoing studies, the actual evidence and the future perspectives concerning drug therapy in this open field.

Reverse time-dependent effect of alphafetoprotein and disease control on survival of patients with Barcelona Clinic Liver Cancer stage C hepatocellular carcinoma.

AIM: To characterize the survival of cirrhotic patients with Barcelona Clinic Liver Cancer (BCLC) stage C hepatocellular carcinoma (HCC) and to ascertain the factors predicting the achievement of disease control (DC). METHODS: The cirrhotic patients with BCLC stage C HCC evaluated by the Hepatocatt multidisciplinary group were subjected to the investigation. Demographic, clinical and tumor features, along with the best tumor response and overall survival were recorded. RESULTS: One hundred and ten BCLC stage C patients were included in the analysis; the median overall survival was 13.4 mo (95%CI: 10.6-17.0). Only alphafetoprotein (AFP) serum level > 200 ng/mL and DC could independently predict survival but in a time dependent manner, the former was significantly associated with increased risk of mortality within the first 6 mo of follow-up (HR = 5.073, 95%CI: 2.159-11.916, P = 0.0002), whereas the latter showed a protective effect against death after one year (HR = 0.110, 95%CI: 0.038-0.314, P < 0.0001). Only patients showing microvascular invasion and/or extrahepatic spread recorded lower chances of achieving DC (OR = 0.263, 95%CI: 0.111-0.622, P = 0.002). CONCLUSION: The BCLC stage C HCC includes a wide heterogeneous group of cirrhotic patients suitable for potentially curative treatments. The reverse and time dependent effect of AFP serum level and DC on patients' survival confers them as useful predictive tools for treatment management and clinical decisions.

Discordancia Capurro-amenorrea en prematurez / Discordance Capurro-amenorrhoea in prematurity

Objetivos: calcular la diferencia entre edad gestacional del recién nacido estimada por examen físico (según el método Capurro) con relación a la edad gestacional esperada por FUM y corroborada por ecografía en un grupo de neonatos nacidos vivos de embarazos únicos menores de 37 semanas. Pacientes: Se estudiaron 208 pacientes que tuvieron su parto en el Hospital Materno Infantil Ramón Sardá entre el 1 de mayo de 2001 y el 31 de enero de 2002, que constituyen el 100 por ciento de los RN pretérmino vivos de ese período. Métodos: Se calculó la diferencia entre la edad gestacional en semanas calculada por FUM cierta (corroborada por ecografía) y la edad gestacional por examen físico del recién nacido por la técnica de Capurro. Fueron excluídas las pacientes con fetos muertos, embarazos múltiples y las que tenían amenorrea incierta por FUM dudosa. Resultados: Fueron consideradas con amenorrea incierta el 21,6 por ciento de las pacientes. De las 163 mujeres con FUM cierta el 52,3 por ciento (n=85) tuvieron una diferencia en más o en menos de 1 semana, que es considerada normal. Se presentó una diferencia mayor de 1 semana en 78 pacientes, siendo mayor la edad gestacional observada por Capurro respecto de la FUM en 59 pacientes (76 por ciento) y menor en 19 (24 por ciento). En 1 recién nacido (0,6 por ciento) la edad gestacional por Capurro fue menor en menos de 3 semanas que la esperada por FUM. Por debajo de las 28 semanas el método de Capurro sobrestima la edad gestacional en promedio 3,4 semanas. Conclusiones: En más de la mitad de los prematuros (52 por ciento) la edad gestacional por examen físico coincide o tiene una mínima discordancia (±1 semana) con la esperada por FUM. A mayor edad gestacional aumenta la equivocación en menos, lo que da un efecto protector a los embarazos de menos edad gestacional, pero muestra en forma evidente que dicho método no debería usarse en estas edades gestacionales.