RESUMO
Acquired hemophilia A (AHA) is a rare hemorrhagic disorder caused by the production of autoantibodies against coagulation factor VIII (FVIII). AHA is associated with significant morbidity and mortality primarily as a result of bleeding. Although many disorders are associated with the development of these inhibitors, up to 50% of cases remain idiopathic. The approach to therapy involves an initial strategy often to control acute bleeding episodes followed by definitive treatment to eradicate the inhibitor with immunosuppressive agents. We present the case of a 63-year-old Caucasian male hospitalized for severe Covid-19 who developed bleeding due to an acquired FVIII inhibitor that had never been treated definitively. Our case presentation focuses on in-hospital management of this patient's acute bleeding episodes with by-passing agents and recombinant porcine factor VIII.
RESUMO
Salivary duct carcinoma (SDC) is an uncommon and highly aggressive tumor associated with high morbidity and mortality. According to the World Health Organization, it is an extremely rare malignancy with an estimated incidence of 1-1.2 in 1,000,000 patients. Standard treatment for SDC is wide surgical resection along with lymph node dissection followed by adjuvant radiation therapy. The role of adjuvant chemotherapy is not known. In this report, we present three cases of SDC. A 71-year-old female with T1N0M0 disease was treated with total parotidectomy, ipsilateral neck dissection, and adjuvant radiotherapy without evidence of disease recurrence at 5 months. The second is a 59-year-old female with TXN1M0 disease who was treated with total parotidectomy with ipsilateral level I-IV neck dissection and adjuvant radiotherapy without evidence of disease occurrence at 21 months. The third case is a 79-year-old male with widely metastatic disease, including brain metastases, treated with cranial irradiation, leuprolide, and lapatinib who remains under home hospice care.
RESUMO
We present a case of a 59-year-old male undergoing adjuvant chemotherapy for his pancreatic adenocarcinoma post-surgical resection. He had an acute rise in carbohydrate antigen (CA) 19-9 level, which raised suspicion of metastatic disease. Instead, the patient was diagnosed to have a liver abscess, the treatment of which brought the CA 19-9 level back to normal. Unfortunately, although CA 19-9 is Food and Drug Administration (FDA)-approved tumor marker for pancreatic cancer, it is also elevated in several benign conditions, causing fear of cancer and unnecessary diagnostic workup. Hence, caution is necessary for interpreting the significance of its elevation.
