The isolated extranodal relapse of the isolated extranodal non- Hodgkin lymphoma: A case report.

Diffuse large lymphomas of B-cell origin (DLBCL) comprise approximately one-third of all non-Hodgkin lymphomas (NHLs) and extranodal involvement is detected in 50% of these cases at initial diagnosis. Primary malignant lymphoma of the adrenal gland is extremely rare. Here we report a 64-year-old male patient with nasopharyngeal lymphoma who had been in remission for 2 years. An adrenal mass was detected on a control abdominal computed tomography (CT) at one of his follow-up visits. The biopsy showed DLBCL. Since the tumor was solitary without any other nodal involvement, a new/de novo primary tumor was considered. Metachronous NHLs develop between 3 months and 15 years after a primary NHLs and VDJ (variable, diversity, joining) rearrangement gene analysis of the tumor tissue is recommended to discriminate recurrence from a metachronous NHLs. VDJ rearrangement gene analysis was consistent with the recurrence of the original neoplasm.

Serum leptin, resistin and TNF-α levels in patients with systemic sclerosis: the role of adipokines in scleroderma.

AIM: Systemic sclerosis (SSc) is a chronic fibrotic collagen tissue disease. Leptin's role in regulating immune and inflammatory response has become increasingly evident. Resistin has pro-inflammatory properties and also is associated with inflammatory markers in some rheumatologic diseases. The purpose of this study was to determine serum leptin, resistin and tumor necrosis factor alpha (TNF-α) in SSc patients and evaluate their association with other frequently used laboratory and clinic findings. METHOD: Sixteen patients were compared with 30 healthy women of similar age and body mass index. Serum leptin, resistin and TNF-α levels were measured by enzyme-linked immunosorbent assay and results were assessed by Mann-Whitney U -test and Spearman's correlation test. RESULTS: Leptin levels were significantly increased in the SSc group compared to controls (7789.43 ± 1180.72 pg/mL, 1790.55 ± 333.68 pg/mL, P < 0.0001). TNF-α was significantly elevated in patients and it was also positively correlated with leptin (25.30 ± 2.16 pg/mL, 20.95 ± 0.30 pg/mL, P = 0.001), (P = 0.002, r = 0.523). There was no association between leptin, resistin, TNF-α levels and skin score, activity score and disease duration in the SSc patients (P > 0.05). CONCLUSION: Leptin, resistin and TNF-α levels were found to be higher in SSc in contrast to the control group. These adipokines may have differentiating roles in the pathogenesis of SSc. In order to verify these findings, further clinical studies are needed with larger patient groups.

An unusual case of hydroa vacciniforme with ocular involvement.

Hydroa vacciniforme (HV) is a sporadic, rare and idiopathic chronic photodermatosis characterized by recurrent vesicles and crust formation on a sun-exposed skin, typically resulting in vacciniform or varioliform scarring. Herein, we report on a 18-year-old boy who presented with rare ocular involvement in HV.

The role of resistin in Behçet's disease: a Turkish experiment.

The objective of this study was to assess the role of resistin, a proinflammatory cytokine potentially involved in Behçet's disease (BD), and to determine its relationship with tumor necrosis factor α (TNF-α), another important inflammatory cytokine known to be involved in BD. Forty-five persons diagnosed with BD were enrolled into this study, 25 of whom were being followed or had recently been diagnosed with clinically active BD, whereas the remaining 20 were previously diagnosed and had clinically inactive BD for the previous 3 months. Thirty persons were recruited as a healthy control group. Patients' C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), resistin, and TNF-α levels were determined with enzyme-linked immunosorbent assay (ELISA). Resistin and TNF-α levels were significantly higher in patients with BD (p < 0.05 and p < 0.05) than in the control group. The major interest of this study was to investigate the role of resistin in patients with BD. An elevated resistin level was associated with activation of BD. Elevated TNF-α and resistin levels could be determined simultaneously, and the presence of these two cytokines together suggests that resistin plays an important role in the pathogenesis and activation of BD.

Esophagus cancer and IgA deficiency in a patient with Dubowitz syndrome: a case report.

Dubowitz syndrome was first described in 1965 by the English physician Dr. Victor Dubowitz. This genetic disorder causes growth retardation both before and after birth. It is primarily diagnosed through the distinctive facial features of affected individuals, including a small triangular-shaped face with a high forehead and wide-set, slitted eyes. The main method of diagnosis is through identification of facial phenotype. Esophageal mass biopsy revealed squamous cell carcinoma type. Both malignancy and IgA deficiency have been reported literature in patients with Dubowitz syndrome. However, Esophagus cancer has not been reported among the malignant tumors. Herein, we reported a patient with Dubowitz syndrome, IgA deficiency and Esophagus cancer.

Urotensin-II in systemic sclerosis: a new peptide in pathogenesis.

Systemic sclerosis (SSc) is a rare multisystem chronic disease and its etiology is still unknown. To obtain and generate reasonable treatment methods, new mediators or targets are needed. Urotensin-II (U-II) is predominantly a vasoactive peptide with fibrotic and prothrombotic features. Like endothelin-1 (ET-1), U-II could play an important role in SSc pathogenesis given its properties of convenient one-to-one SSc pathogenetic pathways. A consecutive group of 55 patients diagnosed with SSc and 30 healthy controls were included in the study. Patients and healthy controls were evaluated for clinical and laboratory manifestations, specific organ involvement, autoantibodies, and activity scores specific for SSc. In addition, plasma ET-1 and plasma levels of U-II-like immunoreactivity of both groups were compared. ET-1 level significantly increased in the SSc group in contrast to the healthy controls (6.38 ± 1.39 and 0.99 ± 0.27 pg/ml; p = 0.006). U-II was also significantly elevated in patients, and the plasma levels of U-II-like immunoreactivity were positively correlated with ET-1 (8.19 ± 1.74 and 1.02 ± 0.19 pg/ml; p = 0.003 and p = 0.0001; r = 0.887). For reasonable treatment of SSc, we need to focus on new targets such as ET-1 and U-II. This study hypothesized that these mediators could have a role in SSc pathogenesis, and U-II antagonist might be a potential alternative therapy for these patients.

Leech therapy for symptomatic relief of cancer pain.

OBJECTIVE: Most patients with advanced stage cancer report moderate to severe pain. The leech (Hirudo medicinalis) is commonly used in traditional medicine for relief of localized pain. DESIGN: We report a case of severe pain related to advanced stage cancer successfully treated by self-applied leeches. SETTING AND PATIENTS: A 62-year-old male patient with synchronous renal cell carcinoma and leiomyosarcoma was admitted with severe pain in the lumbar region. The pain was refractory to radiotherapy, and systemic and epidural analgesic infusion. RESULTS: Two months the patient came to the clinic in good condition free of pain. The patient reported outpatient self-treatment with seven leeches to the lumbar region in the interim that resulted in complete healing of pain. CONCLUSIONS: This is the first report indicating possible activity of leeches in cancer pain.

A case of the Behcet's disease diagnosed by the panniculits after mesotherapy.

We herein report a case of 32-year-old woman who developed erythematous, indurated plaques, nodules on her lower back, hips and inguinal areas which had started after immunotherapy on the injection sites. She had a history of recurrent oral aphthous-like ulcers for 2 years and also had abdominal pain for 2 months. Colonoscopy revealed multiple aphthous ulcers on intestine. Diagnosis of lobular panniculitis was confirmed by histopathological finding of the skin biopsy and she was diagnosed as Behcet's disease. Eruptions due to mesotherapy accepted as hypersensitivity reaction. Before employing this technique, patients should be carefully examined for Behcet's pathognomonic clinical findings.

Successful treatment of refractory adult Still's disease and membranous glomerulonephritis with infliximab.

Adult onset Still's Disease (ASD) is a systemic inflammatory disorder of unknown etiology characterized by chronic and fluctuant fever with accompanying rash, polyarthritis and involvement of multiple organs, especially lymphoid tissues. Although kidney involvement may appear in some cases of adult Still's disease, membranous glomerulonephyritis has not been described before. We herein report a 38-year-old man diagnosed with Still's disease with longstanding polyarthritis unresponsive to high-dose steroids and various immunosuppressive drugs for 5 years. He was referred to our clinic with bilateral pretibial edema on his legs. Urine examination revealed 10.5 g/day proteinuria with membranous glomerulonephritis and his renal biopsy came up with it. Infliximab was initiated, and his complaints were totally resolved also with a normal urine test in the following 3 months. To the best of our knowledge, this is the first report that clearly shows the efficacy of infliximab in a patient with refractory ASD with membranous glomerulonephyritis.

An unusual case of aplastic anemia caused by temozolomide.

Radiotherapy and concomitant/adjuvant therapy with temozolomide are a common treatment regimen for children and adults with high-grade glioma. Although temozolomide is generally safe, it can rarely cause life-threatening complications. Here we report a case of a 31-year-old female patient who underwent surgical resection followed by radiotherapy plus concomitant temozolomide. She developed pancytopenia after adjuvant treatment with temozolomide. A bone marrow aspiration and biopsy showed hypocellularity with very few erythroid and myeloid cells, consistent with aplastic anemia. In the English literature, aplastic anemia due to temozolomide is extremely rare.

Synchronous Hodgkin's disease and gastric adenocarcinoma.

BACKGROUND: Adenocarcinoma is the most frequent pathological type of stomach cancer. Hodgkin's lymphoma is a lymphoproliferative disease arising from lymphoid tissue which is characterized by Reed-Sternberg cells. Synchronous occurrence of these two malignancies has not been reported in the English literature so far. CASE: Here we present a 52-year-old male complaining of epigastric pain and fever diagnosed as stomach adenocarcinoma and Hodgkin's lymphoma. CONCLUSION: It is thought that this case is the first of a synchronous stomach adenocarcinoma and Hodgkin's lymphoma encountered in the English literature. It should be kept in mind that second malignancies can be seen in mass lesions in patients diagnosed with cancer.