An Interesting Case of Alpha-Fetoprotein (AFP)-Producing Pancreaticoduodenal Tumor.

Alpha-fetoprotein (AFP) is considered one of the best-known predictive serum markers, playing a crucial role in cancer investigation and subsequent treatment. In most adult cells, the production of this marker is suppressed after embryogenesis. However, its increased level raises concerns about underlying malignant conditions, which provide a valuable diagnostic tool for medical professionals in oncology. The existing AFP-producing adenocarcinomas exhibit unique clinical characteristics, including high malignancy and early metastatic potential, which result in poorer outcomes. To illustrate these characteristics, we decided to describe a case report of a 70-year-old African American female with a significantly elevated level of AFP. Further pathology results confirmed a duodenal adenocarcinoma versus adenocarcinoma from the pancreas. While AFP-producing adenocarcinoma has multiple underlying molecular mechanisms that correlate with poor prognosis, definitive treatment based on molecular pathways has yet to be defined. Therefore, further research is needed for new therapeutic modalities.

Gastrointestinal Kaposi Sarcoma without Dermatological Lesions: A Case Report.

BACKGROUND Kaposi sarcoma is a malignancy of the vascular endothelium. It is associated with human herpesvirus 8 (HHV-8) infection, typically found with HIV/AIDS. It is rarely seen presenting as visceral involvement without any cutaneous lesions. Few case reports have described this. CASE REPORT We report a case of visceral Kaposi sarcoma (specifically, gastrointestinal lesions) without any cutaneous lesions in a 35-year-old man with HIV/AIDS who presented with abdominal pain, fatigue, and melena of a 15-day duration. Physical examination revealed tachycardia and hypertension, with a negative orthostatic sign. There were no visible signs of bleeding or cutaneous lesions, no abdominal pain, and a digital rectal examination was negative. Laboratory test results were significant for severe microcytic anemia, with hemoglobin level of 3.3 g/dL, decreased ferritin and iron levels, high red cell distribution width, and reticulocyte index lower than appropriate for anemia level. The absolute CD4 count was 33/uL, and the viral load was 56 895 copies/mL. Hemoglobin was optimized with packed red cells prior to endoscopy, and Pneumocystis jirovecii pneumonia prophylaxis was started. Esophagogastroduodenoscopy and colonoscopy revealed small and large bowel hemorrhagic stellate and annular lesions of varying sizes. Pathology reports from biopsy of the lesions seen in the procedure reported Kaposi sarcoma positive for HHV-8. He underwent chemotherapy with doxorubicin and showed clinical and laboratory improvement after treatment. CONCLUSIONS Kaposi sarcoma should be considered and investigated in patients with HIV/AIDS who are not on highly active antiretroviral therapy and present with gastrointestinal bleeding as an initial symptom, without any cutaneous lesions.

Health-Related Quality of Life Among Patients With Sickle Cell Disease in an Adult Hematology Clinic in a Tertiary Hospital in Lagos, Nigeria.

Background Sickle cell disease (SCD) is a genetic disease of public health concern. Improved quality healthcare has increased the life expectancy of these patients; however, they also face an increased frequency of vaso-occlusive crises and other SCD complications. These complications affect their quality of life, an area of care, which healthcare providers often overlook. We sought to determine the health-related quality of life among patients living with sickle cell disease in Lagos, Nigeria.  Materials and methods We conducted a cross-sectional study of 198 patients with sickle cell disease who attended the adult sickle cell clinic at a tertiary hospital in Lagos, Nigeria, during the period from October 1, 2018, to February 28, 2019. A self-administered questionnaire was used to obtain the clinical and socio-demographic characteristics of the patients and the 35-item Short-Form Health Survey (SF-36) questionnaire was used to determine their health-related quality of life (HRQoL). Determinants of HRQoL were established using bivariate and multivariate regression analysis.  Results The mean age of the 198 patients who participated in the study was 28.4±9.1 years, mean steady-state hemoglobin was 8.2 ± 1.3 g/dl, and 85 (42.9%) patients had a monthly income of 150 USD or less. In the previous year, 65 (32.1 %) and 33 (16.6%) patients, respectively, suffered one to two episodes (s) of acute bone pain crises and acute chest syndrome, and 43 (24.7%) had blood transfusion. Using the scoring system for SF-36 provided by RAND Health, role limitation due to physical health had the lowest median score of 50 (interquartile range {IQR}: 0-100). On bivariate analysis, bone pain crisis was associated with statistically significant low scores across all the 8 HRQoL domains of the SF36 questionnaire. Other variables, including having received blood transfusion, recent hospitalization, acute chest syndrome, lower level of income, and younger age, were also associated with significantly low scores. On regression analysis, bone pain crisis, level of income, and acute chest syndrome were found to be independent determinants of quality of life in the patients. Conclusion Sickle cell disease has a negative impact on the health-related quality of life of those affected. The presence of bone pain crisis is an important predictor of health-related quality of life in sickle cell disease patients. To improve patient outcomes, healthcare providers should take a holistic approach in evaluating and managing this disease, taking into cognizance how the complications and the financial burden of this disease impact the quality of life of affected patients.