Adding MYC/BCL2 double expression to NCCN-IPI may not improve prognostic value to an acceptable level.

BACKGROUND: MYC/BCL2 double expression (DE) is associated with poor prognosis in patients with diffuse large B-cell lymphoma (DLBCL) receiving rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone (R-CHOP). This study aimed to determine whether the addition of DE to the National Comprehensive Cancer Network Internal Prognostic Index (NCCN-IPI) could improve the prediction of disease progression in patients with DLBCL treated with R-CHOP. METHODS: This confirmatory prognostic factor study retrospectively recruited patients with newly diagnosed DLBCL between January 1, 2014, and January 31, 2018, at Ramathibodi Hospital (RA) and Thammasat University Hospital (TU). The follow-up period ended on July 1, 2022. Tumors expressing MYC ≥ 40% and BCL2 ≥ 50% were classified as DE. We calculated the hazard ratios (HR) for progression-free survival (PFS) from the date of diagnosis to refractory disease, relapse, or death. Discrimination of the 5-year prediction was based on Cox models using Harrell's concordance index (c-index). RESULTS: A total of 111 patients had DE (39%), NCCN-IPI (8%), and disease progression (46%). The NCCN-IPI adjusted HR of DE was 1.6 (95% confidence interval [CI]: 0.9-2.8; P = 0.117). The baseline NCCN-IPI c-index was 0.63. Adding DE to the NCCN-IPI slightly increased Harrell's concordance index (c-index) to 0.66 (P = 0.119). CONCLUSIONS: Adding DE to the NCCN-IPI may not improve the prognostic value to an acceptable level in resource-limited settings. Multiple independent confirmatory studies from a large cohort of lymphoma registries have provided additional evidence for the clinical utility of DE.

The Human Placental Amniotic Membrane Mesenchymal-Stromal-Cell-Derived Conditioned Medium Inhibits Growth and Promotes Apoptosis of Human Cholangiocarcinoma Cells In Vitro and In Vivo by Suppressing IL-6/JAK2/STAT3 Signaling.

Mesenchymal stromal cells (MSCs) have recently been shown to play an important role in the growth and progression of many solid tumors, including cholangiocarcinoma (CCA). The human placental amniotic membrane (hPAM) is one of the most favorable sources of MSCs due to its availability and non-invasive harvesting procedure. However, the role of human placental amniotic membrane mesenchymal stromal cells (hPAMSCs) in the growth and progression of human CCA has not yet been determined. This study investigates the effects of conditioned medium derived from hPAMSCs (PA-CM) on the properties of three human CCA cell lines and explores possible mechanisms of action. Varying concentrations of PA-CM were used to treat CCA cells to determine their effects on the proliferation and apoptosis of CCA cells. The results showed that PA-CM inhibited the proliferation and colony-forming capacity of KKU100, KKU213A, and KKU213B cells. PA-CM also promoted the apoptosis of these CCA cells by causing the loss of mitochondrial membrane potential. Western Blotting confirmed that PA-CM induced CCA cell apoptosis by increasing the levels of the Bax/Bcl-2 ratio, cleaved caspase 3, and cleaved PARP, possibly by inhibiting the IL-6/JAK2/STAT3 signaling pathway. Moreover, our in vivo study also confirmed the suppressive effect of hPAMSCs on CCA cells by showing that PA-CM reduced tumor volume in nude mice transplanted with human CCA cells. Taken together, our results demonstrate that PA-CM has potent tumor-suppressive effects on human CCA cells and could potentially be used in combination with chemotherapy to develop a more effective treatment for CCA patients.

Acute respiratory distress syndrome following breast augmentation managed by delayed veno-venous extracorporeal membrane oxygenation.

The initiation of veno-venous extracorporeal membrane oxygenation (VV-ECMO) has been opposed in late-phase acute respiratory distress syndrome (ARDS) due to an increase in mortality. Herewith an individual case of a 20-year-old female who survived severe ARDS after breast augmentation is reported, whose delayed transfer to our tertiary referral center led to a late initiation of VV-ECMO and multiple mechanical ventilation-associated complications. Nonetheless, her VV-ECMO was decannulated after 45 days of ARDS onset, considering an awake ECMO strategy possibly contributing to her positive outcome. We also provided spirometry results and chest radiography findings over the three years of follow-up. Intensive care specialists need to consider the potential use of ECMO in late-phase ARDS with selected patients.

External validation and comparison of IPI, R-IPI, and NCCN-IPI in diffuse large B-cell lymphoma patients treated with R-CHOP to predict 2-year progression-free survival.

BACKGROUND: Diffuse large B-cell lymphoma (DLBCL) is the most common aggressive lymphoma. The standard first-line therapy for DLBCL consists of rituximab cyclophosphamide doxorubicin vincristine and prednisone (R-CHOP). About 50-70% of patients may be cured by R-CHOP. There was no data on external validation and comparison of the international prognostic index, revised-IPI (R-IPI), and enhanced-IPI (NCCN-IPI) to predict treatment outcomes in the middle-income country with a resourced-limited setting. OBJECTIVES: We aimed to externally validate and compare IPI, R-IPI, and NCCN-IPI in predicting 2-year progression-free survival (2-y PFS) of newly diagnosed DLBCL patients treated with R-CHOP. METHODS: This ambispective observational study recruited consecutive patients diagnosed between 1 January 2014 and 30 June 2020, with the last follow-up on 1 July 2022 from Thammasat University Hospital and Ramathibodi Hospital. We assessed discrimination by Harrell's concordance index (c-index), calibration by calibration plot, and absolute difference in survival (ADS) between the lowest-and the highest-risk groups. RESULTS: The cohort of 292 patients (median age 63 years and median follow-up 3.6 years) had 131 progressions and 96 deaths. The 2-y PFS was 63%. The c-indices were NCCN-IPI 0.6216, R-IPI 0.6004 (P = 0.215), and IPI 0.6104 (P = 0.463). The calibration plots of NCCN-IPI and R-IPI showed nearly perfect agreement (moderate strength), while IPI had miscalibrations. The ADSs were NCCN-IPI 52%, R-IPI 42%, and IPI 25%. CONCLUSION: NCCN-IPI is the best prognostic index compared to IPI and R-IPI in prior studies. However, the prognostic model for DLBCL patients treated with R-CHOP requires updating or integrating biomarkers to improve discrimination to the acceptable level (c-index 0.7).

Breast implant-associated anaplastic large cell lymphoma in an Asian patient: The first case report from Thailand.

Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) has received increasing interest among plastic surgeons as a long-term complication of breast augmentation. Although the prognosis is usually good, mortality is a possible outcome. Most of the cases reported in the past two decades have been from the United States, Europe, and Australia, whereas cases of BIA-ALCL in Asia remain rare. Herein, we describe the first known case of BIA-ALCL in Thailand, in which a 32-year-old woman developed BIA-ALCL 3 years after breast augmentation using textured implants. The patient underwent bilateral removal of the implants and ipsilateral total capsulectomy. This case report-the first of its kind from Thailand-should increase awareness of BIA-ALCL among plastic surgeons in Asia. The true incidence of BIA-ALCL in Asia may be underreported.

Non-Hodgkin lymphoma in South East Asia: An analysis of the histopathology, clinical features, and survival from Thailand.

Systemic reports on the descriptive epidemiology of non-Hodgkin lymphoma (NHL) from Southeast Asia are scarce. A nationwide multi-institutional registry was conducted to compare the histopathology, clinical features, and survival of Thai adult patients with NHL using large registries, especially those from Far East Asia (FEA). Using a web-based registry system, 13 major medical centers from the 4 geographic regions of Thailand prospectively collected, from 2007 to 2014, the diagnostic pathology, according to the World Health Organization classification, 2008, clinical features and survival of 4056 patients who were newly diagnosed with NHL. The median age of the patients was 56 years (range, 16-99 years). The male-to-female ratio was 1.3:1. From the total of 4056 patients, T/NK-cell lymphoma (TNKCL) accounted for 12.6% of cases, and 5.1% had human immunodeficiency virus-associated lymphoma. The four leading histological subtypes were diffuse large B-cell lymphoma, not otherwise specified (58.1%); follicular lymphoma (5.6%); extranodal mucosa-associated lymphoid tissue lymphoma (5.2%); and peripheral T-cell lymphoma, not otherwise specified (4.0%). With a median follow-up duration of 46.1 months, the median overall survival of B-cell NHL was significantly longer than that of patients with TNKCL (76.5 vs 28.8 months, P = .0001). Compared to FEA, the Thai registry had an approximately one-half lower relative frequency of TNKCL; the prevalence of extranodal mucosa-associated lymphoid tissue lymphoma was much lower than in Korea, and the frequency of extranodal TNKCL, nasal type, was strikingly low compared to China. It is concluded that while the median age of Thai patients with NHL was approximately a decade younger than for Caucasians, the long-term survival rates for most histological subtypes were comparable. While the histological distribution generally complied with the characteristic Asian features, some differences from FEA were observed.

Accuracy of Bone Marrow Flow Cytometry Analysis in Patients With Plasma Cell Neoplasm in Thailand: A Single Institutional Study.

BACKGROUND: Plasma cell neoplasm is a common hematologic malignancy. Treatment with novel agents results in favorable outcomes. Reliable investigations are required to monitor the residual disease, especially after such effective treatments. Flow cytometric analysis is a speedy and accurate method to detect abnormal cells. The aim of this study was to determine diagnostic performance of flow cytometry in the detection of abnormal plasma cells in bone marrow specimens. MATERIALS AND METHODS: We included bone marrow samples taken from patients suspected to harbor plasma cell neoplasm at the time of diagnosis or follow-up after treatment from 2013 to 2015. Flow cytometric analyses, using cluster of differentiation (CD)19/CD20/CD27/CD38/CD45/CD56/CD117/CD138 and cytoplasmic κ/λ, were done and results compared with morphologic evaluation of marrow aspirate smear, histology, and immunohistochemistry of marrow biopsy and protein electrophoretic analyses. RESULTS: A total of 154 specimens were included. Plasma cell neoplasm was detected in 56 samples (36.4%). Most abnormal plasma cells in this study were CD19-negative (CD19(-))/CD20(-)/CD27(+)/CD38(+)/CD45(-) (or weakly positive)/CD56(+)/CD117(+)/CD138(+). Light chain restriction was found only in 18 samples (32.1%). Sensitivity and specificity of flow cytometric analysis were 91.1% and 96.9%, respectively. For the follow-up cohort, sensitivity and specificity were 86.7% and 66.7%, respectively. CONCLUSION: Analysis of plasma cell neoplasm using flow cytometry has high sensitivity and specificity. As an adjunct to marrow histology and immunohistochemistry, flow cytometry can be used in diagnosis of plasma cell neoplasm and more importantly in monitoring the disease after treatment. We propose a limited panel of CD19/CD38/CD45/CD56/CD117/CD138 for detecting minimal residual disease in Thai patients.

Failed conservative treatment of synchronous primary cancer of endometrium and ovary in a young Thai woman: a case report.

A case of well differentiated endometriod adenocarcinoma of the endometrium with a synchronous endometriod and clear cell adenocarcinoma of both ovaries was reported. Recently, a 28-year-old woman presented with vaginal bleeding was diagnosed to have only FIGO stage IaG1 (FIGO 2000) cancer of the endometrium. After 3 months of high dose progestin treatment, 15 cm bilateral ovarian tumors later diagnosed as FIGO stage IIIa ovarian cancer (mixed endometriod and clear cell adenocarcinoma) were detected, and later surgically removed. The patient then was started on Placitaxel/Carboplatin combination chemotherapy for 6 cycles after surgery. The synchronous cancers of endometrium and ovary are usually presented in woman with median age of 50 with obesity, diabetes, and hypertension. These low grade tumors and better prognosis are the norm in contrast to the authors' case with clear cell component and higher stage of ovarian cancer in young lean Thai woman.

NK/T cell lymphoma, nasal type with sinonasal mass and palatal ulcer: a clinical case report and review of treatment.

Extranodal Nasal NK/T cell lymphoma, relatively uncommon type of non-Hodgkin's lymphoma, is highly aggressive disease with poor outcomes. Early stage disease may response to radiotherapy alone. However the treatments are usually chemotherapy and radiotherapy combination and late stage disease may not response to any available therapy. We reported a 45-year-old woman with extranodal nasal type NK/T cell lymphoma. The patient presented with chronic nasal stuffiness and mucous bloody discharge. The nasal mass is extensively involved periorbital and sinonasal soft tissue. Due to the extensively involved of tumor, combination chemotherapy was used to induce response. This patient was involved by complicated infection and palatal ulcer with likely perforation. The salvage chemotherapy was given and the treatment of NK/T cell lymphoma from other reports and literatures were reviewed.

Diffuse pachymeningitis due to Mycobacterium tuberculosis: a case report and review of the literature.

Diffuse pachymeningitis is an uncommon presentation of tuberculous meningitis (TBM). We present a 78-year-old woman patient with a 1-year history of progressive headache and MRI of the brain compatible with diffuse pachymeningitis. Without strong evidence to support a diagnosis, she subsequently underwent dural biopsy which revealed caseous granulomatous inflammation and was positive for Mycobacterium tuberculosis complex by PCR. The dura tissue culture subsequently confirmed the diagnosis of TBM. Successful treatment with antituberculous drugs and corticosteroid was observed without complications. Literature review on characteristics, diagnoses and treatment of central nervous system tuberculosis was also performed.

Natural killer cell malignancy associated with Epstein-Barr virus and hemophagocytic syndrome.

Natural killer cell malignancy is a rare and aggressive lymphoid neoplasm encompassing extra-nodal NK/T-cell lymphoma, nasal-type (ENKLN) and aggressive NK-cell lymphoma/leukemia (ANKL). A case of cutaneous ENKLN and a case of ANKL in Thai patients are reported Both patients developed hemophagocytic syndrome and shortly succumbed to death. The cells in cutaneous ENKLN are small to medium in size with minimal cytoplasm, round nuclei, irregular nuclear membrane, andfine chromatin with inconspicuous nucleoli. While that of ANKL are medium to large-sized mononuclear cells with moderate cytoplasm. Their nuclei are elongated to embryo-like with irregularly thickened nuclear membrane, fine chromatin, and small to occasional prominent nucleolus. Ancillary techniques studied on paraffin embedded tissues of both cases demonstrated that the neoplastic cells exhibit cytoplasmic CD3+, CD56+ and cytotoxic granules + by immunohistochemistry, absence of T cell receptor gene rearrangement by PCR, and presence of Epstein-Barr virus mRNA (EBER) transcripts by in situ hybridization. The authors reviewed the literature on natural killer cell neoplasm and compared the clinical characteristics, natural history, and association of Epstein-Barr virus infection with hemophagocytic syndrome.

IgA nephropathy associated with Hodgkin's disease in children: a case report, literature review and urinary proteome analysis.

We report herein a rare case of IgAN associated with Hodgkin's disease in a 14-year-old boy. Clinical manifestations and laboratory parameters were improved after treatment with CHOP chemotherapy and enalapril. Urinary proteins were isolated and examined using state-of-the-art proteomic technology, before and during the treatment course. Two-dimensional gel electrophoresis showed obvious alterations in the urinary proteome profile in response to such therapy. Quantitative intensity analysis and gel mapping revealed 14 altered proteins with reduced excretion levels during the treatment course, including albumin, albumin complexed with decanoic acid, alpha-1 antitrypsin, cadherin-11 precursor, collagen alpha 1 (VI) chain precursor, complement C1q tumor necrosis factor-related protein, Ig heavy chain, Ig light chain, kininogen, inter-alpha-trypsin inhibitor (alpha-1 microglobulin), inter-alpha-trypsin inhibitor heavy chain, leucine-rich alpha-2 glycoprotein, beta-2 microglobulin, and transferrin precursor. Their potential roles in the pathogenesis and pathophysiology of IgAN are discussed.