A rare case of epithelial-myoepithelial carcinoma ex pleomorphic adenoma of the parotid gland: Radiologic-pathologic correlation.

Carcinoma ex pleomorphic adenoma is a carcinoma that arises from a primary or recurrent benign pleomorphic adenoma. The prevalence of epithelial-myoepithelial carcinoma is low, and this histological type accounting for only 1% of all salivary gland tumors. Here, we report a rare case of Epithelial-Myoepithelial Carcinoma ex pleomorphic adenoma of the parotid gland with a radiologic-pathologic correlation.

BCR/ABL1-positive B-lymphoblastic Lymphoma Successfully Treated with Dasatinib-combined Chemotherapy.

We herein report a rare case of BCR-ABL1-positive B-lymphoblastic lymphoma (B-LBL). An 18-year-old woman had a history of persistent left-sided chest pain. Positron emission tomography showed increased metabolic activity in the fifth rib, duodenum, and pancreas. The pathological findings of the pancreas, duodenum, and bone marrow confirmed the diagnosis of B-LBL. Polymerase chain reaction of duodenum and bone marrow also revealed a minor BCR-ABL1 fusion gene. She was diagnosed with BCR-ABL1-positive B-LBL and administered dasatinib and prednisolone. She achieved complete remission two weeks after the initiation of the treatment. She received stem cell transplantation after consolidation chemotherapy and sustained complete remission.

Maternal Knowledge Associated with the Prevalence of Iron and Folic Acid Supplementation Among Pregnant Women in Muntinlupa, Philippines: A Cross-Sectional Study.

PURPOSE: The World Health Organization advocates that all pregnant women in areas where anemia is prevalent receive supplements of iron and folic acid. However, owing to a myriad of factors, the uptake of iron and folic acid supplementation (IFAS) is still low in many countries. Therefore, this study was conducted to assess the prevalence of IFAS and its associated factors among pregnant women. PATIENTS AND METHODS: A cross-sectional study was conducted at a hospital in Muntinlupa, Philippines, between March and August 2019 among 280 pregnant women. A systematic random sampling technique was used to select participants. Data were collected using interviewer-administered questionnaires. Multivariable logistic regression analyses were employed to identify factors associated with the prevalence of IFAS among pregnant women. RESULTS: Among 280 pregnant women, a majority (85.6%, n= 238) took IFAS during pregnancy. Among the respondents, 128 (45.9%) women had knowledge about signs and symptoms of anemia, 126 (45.3%) had knowledge of the benefits associated with IFAS, and 42 (15.4%) had knowledge about side effects associated with IFAS. The main sources of information about IFAS were health care providers (41.8%), followed by community health workers (CHWs) (14.6%). Maternal knowledge concerning IFAS benefits (OR = 2.50, CI = 1.04-5.97, p=0.04) was positively associated with the prevalence of IFAS. CONCLUSION: Maternal knowledge about the benefits of taking IFAS was significantly associated with the prevalence of IFAS among pregnant women in Muntinlupa, Philippines. There is a pressing need to improve health education on the benefits of IFAS among pregnant women to increase its prevalence. This emphasizes the necessity of increased involvement of health care providers and CHWs to increase women's knowledge of IFAS benefits and support them through pregnancy.

Pathological assessment of the lymph node biopsies for lymphadenopathy in rheumatoid arthritis.

Objectives: To assess the incidence of reactive lymph node hyperplasia (RLH) and the diagnostic characteristics that can help differentiate it from lymphoproliferative disorders (LPD) in patients with rheumatoid arthritis (RA).Methods: Data on patient characteristic from 32 consecutive RA patients with lymphadenopathy at a single medical center over a 6-year period were collected and analyzed to determine whether any of these characteristics can differentiated RLH from LPD.Results: LPD including methotrexate (MTX) - associated LPD (MTX-LPD) and RLH were diagnosed in 19 and 10 patients, respectively. Conclusive diagnosis was not reached in the remaining three cases and they were regarded as grey-zone cases. Age, levels of lactate dehydrogenase (LDH) and soluble interleukin-2 receptor (sIL-2R), as well as maximum standardized uptake value (SUVmax), were significantly higher in LPD than in RLH patients. The diagnosis cut-off values for these parameters were 66 year, 169 U/L, 899 U/mL and 8.18, respectively, based on the receiver operating characteristics curve analysis for both RLH and LPD.Conclusions: About one-third of patients with RA who presented with lymphadenopathy had reactive lymph node enlargement. Older age and higher levels of LDH, sIL-2R, and SUVmax are more associated with LPD than should be considered when deciding to perform a biopsy.

[A Case of Segmental Arterial Mediolysis:Subarachnoid Hemorrhage Followed by Abdominal Bleeding].

We describe a case involving subarachnoid and intraperitoneal hemorrhage due to segmental arterial mediolysis(SAM). A 77-year-old female patient with sudden subarachnoid hemorrhage was immediately transferred to our institution. The hemorrhage was classified as grade 2 according to the World Federation of Neurosurgical Societies system. The patient was a non-smoker and did not drink alcohol regularly. A right internal carotid aneurysm was detected using CT angiography and was clipped during frontotemporal craniotomy. Bleeding was observed from the anterior wall of the internal carotid artery, and the tear was clipped. The patient had an uneventful postoperative course until sudden cardiopulmonary arrest eight days after craniotomy. She died of massive intraperitoneal hemorrhage. Autopsy revealed that the hemorrhage was due to dissection of the celiac artery. Tunica media denaturation was observed not only in the celiac artery, but also in the splenic and internal carotid arteries, which exhibited ruptured aneurysms, and the patient was diagnosed with segmental arterial mediolysis(SAM). SAM is an arterial degenerative disease affecting the medial layer of the arterial and dissecting walls. Multiple lesions are sometimes found. Radiographic imaging findings of SAM are similar to those of dissecting aneurysms, which are characterized by a single continuous dissection of the medial layer. As observed in this case, abdominal bleeding caused by SAM can occur after intracranial bleeding. When surgeons encounter unusual intracranial dissecting aneurysms, SAM should be considered as a differential diagnosis.

An autopsy case of macroglobulinemia complicated with syndrome of inappropriate secretion of ADH (SIADH) like hyponatremia, hypopituitarism and AL amyloidosis.

An 88-year-old male patient with macroglobulinemia was admitted to our hospital because of severe hyponatremia and unconsciousness. Laboratory findings showed decreased inhibition of antidiuretic hormone (ADH) and he was diagnosed with syndrome of inappropriate secretion of ADH (SIADH). Hyponatremia improved with only limitation of water intake and the patient was followed up on a continuing outpatient basis. However, soon after discharge from hospital, his legs started swelling with edema and hyponatremia worsened. He was re-admitted due to a fall at home. Hyponatremia was observed at re-admission. A CRH challenge test showed partial dysfunction of ACTH secretion. Corticosteroid therapy was performed, but the patient subsequently died from pneumonia. Pathological findings at autopsy revealed invasion of plasma cells and amyloid depositions in multiple organs, including the pituitary, adrenal cortex, heart, liver, kidney, lymph nodes and bone marrow. Consistent with these results, fibrosis was observed in the anterior lobe of the pituitary, suggesting that the autopsy findings were related to the clinical observations and diagnosis. This is the first reported case of macroglobulinemia complicated with multiple hormone dysfunction.

Inhibition of N-acetylgalactosamine 4-sulfate 6-O-sulfotransferase by beta-D-4-O-sulfo-N-acetylgalactosaminides bearing various hydrophobic aglycons.

N-acetylgalactosamine 4-sulfate 6-O-sulfotransferase (GalNAc4S-6ST) transfers sulfate to position 6 of GalNAc(4SO4) residues of chondroitin sulfate to yield chondroitin sulfate E (CS-E). We have previously demonstrated that phenyl-beta-D-GalNAc(4SO4) could serve as an acceptor for GalNAc4S-6ST, thereby inhibiting GalNAc4S-6ST competitively. In this paper we compared the inhibitory effects of various glycosides in which various hydrophobic aglycons were attached to D-GalNAc(4SO4) via ss anomeric configuration. p-Nitrophenyl-beta-D-GalNAc(4SO4) and p-chlorophenyl-beta-D-GalNAc(4SO4) were stronger inhibitors than phenyl-beta-D-GalNAc(4SO4). Among inhibitors examined here, 3-estradiol-beta-D-GalNAc(4SO4) was the strongest inhibitor; the Ki of 3-estradiol-beta-D-GalNAc(4SO4) for the competitive inhibition was 0.008 mM, which was much lower than the Ki of phenyl-beta-D-GalNAc(4SO4), 0.98 mM. In contrast, 7-estradiol-beta-D-GalNAc(4SO4) showed only weak inhibition to GalNAc4S-6ST. 3-Estradiol-beta-D-GalNAc(4SO4) did not inhibit chondroitin 6-sulfotransferase and chondroitin 4-sulfotransferase under the concentration where GalNAc4S-6ST was inhibited by 90%. When 3-estradiol-beta-D-GalNAc(4SO4) was added to the culture medium of chondrosarcoma cells expressing human GalNAc4S-6ST, a significant, albeit small, reduction in the cellular synthesis of CS-E was observed. These results suggest that estradiol group of 3-estradiol-beta-D-GalNAc(4SO4) may enhance the inhibitory activity of the glycoside through increasing the affinity to the enzyme and may allow the glycosides to diffuse at a low efficiency into the cells to inhibit cellular synthesis of CS-E.

Palliative care needs of cancer outpatients receiving chemotherapy: an audit of a clinical screening project.

PURPOSE: Although more and more cancer patients are receiving chemotherapy in outpatient settings in their advanced stage and could have a broad range of palliative care needs, referral to the specialized palliative care service is often delayed. The primary aim of this study is to explore the usefulness of a combined intervention for cancer patients in identifying patients with under-recognized palliative care needs and referring them to the specialized palliative care service. The intervention consisted of (1) introducing the specialized palliative care service when starting chemotherapy, (2) using screening tools, and (3) providing on-demand specialized palliative care service. MATERIALS AND METHODS: All cancer patients newly starting chemotherapy with primary tumor sites of the lung, gastrointestine, pancreas, bile duct, breast, ovary, and uterus were included. As routine practice, at the first instruction about chemotherapy, pharmacists provided information about the role of the specialized palliative care service using a pamphlet and handed out screening questionnaires. Screening questionnaires were distributed at every hospital visit. Treating physicians and/or nurses checked the questionnaire before examining the patients. The patients were referred to the palliative care team, if (1) the patients voluntarily wished for the specialized palliative care service or (2) the treating physicians clinically determined that, on the basis of the screening results, the patients had physical or psychological needs appropriate for referral to the specialized palliative care service. The screening questionnaire included an open-ended question about their greatest concerns, the severity of 11 physical symptoms, overall quality-of-life, the distress thermometer, help for information about the treatment and decision-making, economic problems, nutrition, daily activities, and wish for help from the specialized palliative care service. RESULTS: Of 211 patients who newly started chemotherapy, 5 patients refused to complete the questionnaire (compliance rate, 98%). We obtained 1,000 questionnaires from 206 patients. The percentages of missing values ranged from 2.7% to 7.0%. Of 206 patients, 38 (18%) were referred to the palliative care team due to newly recognized problems, in addition to 10 patients with problems well-recognized by primary physicians. The total percentage of patients receiving specialized palliative care service was thus 23% of all patients. Frequently identified problems were oral problems (20%), insomnia (20%), help with information and decision-making (16%), psychological distress defined as the distress thermometer (14%), severe fatigue (9.0%), and severe appetite loss (8.8%). As a whole, problems were identified in half of all questionnaires. CONCLUSION: The combined intervention of introducing the specialized palliative care service, using screening tools and providing on-demand specialized palliative care service, was feasible as part of the routine clinical practice for all cancer patients starting chemotherapy. It might be useful in identifying patients with under-recognized palliative care needs and referring them to the specialized palliative care service at the appropriate time.