Chameleonic Chloroma: A Case of Myeloid Sarcoma Presenting as a Pancreatic Head Mass.

We report a case of pancreatic myeloid sarcoma (MS), an extremely rare manifestation of acute myeloid leukemia (AML), in a 35-year-old male who presented with epigastric pain and watery stools. Initial diagnostic testing was inconclusive; however, following an extensive evaluation, endoscopic biopsies suggested AML, which was confirmed by a bone marrow biopsy. Given that few cases are documented in the literature, pancreatic MS without a preexisting hematologic malignancy poses a significant diagnostic challenge.

Prevalence and Predictors of High-Grade Anal Dysplasia in People With HIV in One Southeastern Ryan White HIV/AIDS Program Clinic.

Background: Prevalence of anal cancer is increasing among people with HIV (PWH). Screening for anal cancer involves evaluating cytology and biopsy with high-resolution anoscopy (HRA) if indicated. In this study, we sought to identify the prevalence of abnormal anal cytology and biopsy-proven high-grade dysplasia, defined as anal intraepithelial neoplasia 2 and 3 (AIN2+). Methods: Demographic and clinical data were collected from participants age ≥30 years with ≥1 anal Pap smear performed during the study period (12/18/2017-05/29/2021). A subgroup analysis was performed on those with ≥1 HRA. Logistic regression estimated adjusted odds ratios (aORs) for variables of interest such as age, race, gender, presence of HPV strains, and sexual practices. Results: Of 317 participants, 48% (n = 152) had abnormal cytology (93% low-grade squamous intraepithelial lesion [SIL] or atypical cells of undetermined significance [ASCUS] and 7% high-grade SIL). Most with abnormal cytology proceeded to HRA (n = 136/152). Of those with HRA, 62% (n = 84/136) had AIN2+. History of anoreceptive intercourse (aOR 4.62; 95% CI 1.08-23.09; P = .047), HPV 16 (aOR 4.13; 95% CI 1.63-11.30; P = .004), and "other" high-risk HPV strains (aOR 5.66; 95% CI 2.31-14.78; P < .001) were significantly associated with AIN2+. Conclusions: Nearly half of those screened had abnormal cytology, highlighting the high prevalence of anal dysplasia in PWH. Though only 7% had high-grade SIL on cytology, 62% of those biopsied had AIN2+, suggesting that cytology underestimates the severity of dysplasia on biopsy. HPV 16 and "other" high-risk strains were associated with AIN2 + and could be considered for risk-stratifying patients in the screening algorithm.

Evaluating the cascade of care for anal cancer screening within a Ryan White HIV/AIDS Program clinic.

BACKGROUND: Care cascades can inform providers about differences in engagement and retention in care between patient populations thereby improving participation by targeting interventions more effectively. The objective of this study was to assess the uptake and retention of participants along the anal cancer screening algorithm within a single HIV clinic. METHODS: Retrospective procedural and demographic data were collected within a Ryan White HIV/AIDS Program clinic from 18 December 2017 to 29 May 2021. A care cascade was constructed among eligible participants who engaged and were retained in the anal cancer screening algorithm. Engagement was defined as having at least one anal Pap smear. Retention was defined as having a follow-up anal Pap smear, and/or high resolution anoscopy, as indicated. Risk ratios (RR) were calculated to reveal factors associated with initiation and retention in screening. RESULTS: Of 821 eligible participants, 312 (38%) engaged in screening and 205 (66%) were retained in care. Anoreceptive intercourse was positively associated with engagement (RR 2.81, 95% confidence interval [CI] 2.05-3.90, p<0.001), whereas male gender was negatively associated (RR 0.26, 95% CI 0.20-0.33, p<0.001). Abnormal cytology results on Pap smear were associated with retention (RR 1.39, 95% CI 1.03-1.86, p=0.03). CONCLUSIONS: Overall engagement in anal cancer screening is low within our clinic, particularly among men, but retention in the screening program is notably better, especially among those with abnormal cytology. Target populations have been identified to increase awareness, and qualitative studies are underway to understand perceptions and barriers to engagement in anal cancer screening.

Prevalencia de cáncer del aparato digestivo en población derechohabiente del IMSS en el Estado de Sinaloa, México / Prevalence of digestive tract cancer in IMSS patients in Sinaloa, Mexico

Objetivo: Determinar la frecuencias de neoplasias malignas del aparato digestivo en derechohabientes atendidos en hospital de concentración del IMSS en Culiacán, Sinaloa, México. Método: De 32,067 reportes histopatológicos realizados en el Departamanto de Patología del Hospital General Regional No. 1 del IMSS en Culiacán, Sínaloa, se identificaron 406 estudios reportados con neoplasia maligna del tubo digestivo (NMTD); edad y sexo de los pacientes fueron analizados así como sitio de afección y estirpe histológica. Neoplasias benignas y metastásicas fueron excluidas. Resultados: Prevalencia NMTD: 1.26 por ciento; edad más afectada: 60-69 años; predilección por sujetos masculinos (66 por ciento), p < 0.0001. Globalmente, 47.2 por ciento de los estudios reportaron cáncer gástrico, 17.5 por ciento colon y recto, 8.4 por ciento vesícula y vías biliares, 8.1 por ciento cáncer hepático, el resto localizado en otros niveles. Tasas de NMTD por estirpe histológica similares a las de otros hospitales de concentración del país. Conclusiones: NMTD en población derechohabiente del IMSS en Sinaloa con magnitud relevante al considerar las registradas en otros centros hospitalarios. Posiblemente existen factores regionales que contribuyen a este comportamiento