RESUMO
Cancer antigen 125 (CA-125) is a transmembrane glycoprotein, and it is known to be an essential biomarker in detecting treatment response and recurrence of ovarian cancer. It may also be used in monitoring colorectal cancer. It tends to rise in states of inflammation. Recent studies have demonstrated a temporary rise in CA-125 levels and other cancer biomarkers in patients suffering from coronavirus disease 2019 (COVID-19) infection. However, in the following case report, we hope to shed light on a possible association between CA-125 levels and the COVID-19 mRNA vaccine. We present the case of a 79-year-old woman with moderately differentiated adenocarcinoma of the right adnexa, who had a transient increase in CA-125 levels after a period, during which she underwent treatment for COVID-19 infection and received the first dose of COVID-19 mRNA (Pfizer-BioNTech) vaccine with no evidence of disease progression on imaging.
RESUMO
Hairy cell leukemia (HCL) is an infrequently encountered chronic B-lymphocyte hematological malignancy, which is found to be more prevalent in males. HCL can present with a myriad of nonspecific symptoms involving the reticuloendothelial system. Usually, patients are diagnosed after an incidental finding of pancytopenia. In the majority of cases, HCL follows an indolent course, and many patients remain asymptomatic. Treatment with nucleoside analogs is the first line of treatment and is indicated for patients with severe anemia, thrombocytopenia, neutropenia, or severe systemic symptoms. Here, we report an atypical case of a 41-year-old Hispanic female who presented with menorrhagia and iron deficiency anemia. She was diagnosed with HCL after a bone marrow biopsy demonstrated the characteristic "hairy projections."
RESUMO
Thrombocytopenia is a common entity seen in ICU patients and is associated with increased morbidity such as bleeding and transfusions, and mortality in ICU patients. Various mechanisms such as decreased platelet production, sequestration, destruction, consumption, and sometimes a combination of these factors contribute to thrombocytopenia. An understanding of the mechanism is essential to diagnose the cause of thrombocytopenia and to help provide appropriate management. The management strategies are aimed at treating the underlying disorder, such as platelet transfusion to treat complications like bleeding. Several studies have aimed to provide the threshold for platelet transfusions in various clinical settings and recommend a conservative approach in the appropriate scenario. In this review, we discuss various pathophysiological mechanisms of thrombocytopenia and the diverse scenarios of thrombocytopenia encountered in the ICU setting to shed light on the varied thresholds for platelet transfusion, alternative agents to platelet transfusion, and future directions for the implementation of thromboelastography (TEG) in multiple clinical scenarios to assist in the administration of appropriate blood products to correct coagulopathy.
RESUMO
A 60-year-old African-American male presented to the emergency department with abdominal pain and distention associated with decreased appetite and weight loss for several weeks. A computed tomography (CT) scan of the abdomen and pelvis showed an 8 cm mesenteric mass with surrounding stranding and poorly defined borders. The patient underwent exploratory laparotomy and complete resection of the mass since the frozen section could not give a definite diagnosis. Histopathology showed fibro-adipose tissue with lymphoid hyperplasia, vague nodular collections of foamy histiocytes with giant cell reaction, marked chronic inflammation, fat necrosis, and prominent sclerosis/fibrosis. Methenamine silver and acid-fast stains were negative for fungal and mycobacterial organisms respectively. Examination of tissue with immunohistostains showed increased immunoglobulin G4 (IgG4)-positive plasma cells. Other features observed were scattered areas of phlebitis, pockets of tissue eosinophilia, and focal storiform fibrosis leading to the diagnosis of IgG4-related sclerosing mesenteritis. The patient did not require steroids after the surgical resection and was disease free at six-month follow up.
RESUMO
Intraocular metastatic tumors have been increasingly reported in the recent past. Unlike choroidal metastasis, metastasis to retina is very rare and so far has been reported in very few case reports only. A 56 year-old male who presented with a history of adenocarcinoma of the cecum and underwent lap colectomy for the primary cecal tumor, received adjuvant chemotherapy for a year after surgery and decided to stop. He was also diagnosed with metastasis to liver and lung at this time. He presented with left eye pain, pressure and decreased vision suspicious for retinal metastasis from cecal primary lesion, 2 years after initial diagnosis. A mass of 5 x 10 mm was found on ophthalmoscopic examination and on ultrasound of the eye, in spite of normal results of MRI of the orbit. Palliative radiation therapy of the left eye resulted in decreased eye pressure and improved vision. As retinal metastasis carries a poorer prognosis due to higher risk of spread to central nervous system, the diagnosis of retinal metastasis in case of gastrointestinal cancers patients who present with vision changes should be made urgently. These patients should be thoroughly investigated with a synergistic approach of opthalmoscopic examination, ultrasound of the eye along with other imaging modalities like MRI of the orbit and just not MRI of orbit. Immediate action in the form of surgical or radiation treatments of the metastatic tumors of the eye should be instituted early on for a better prognosis.