RESUMO
BACKGROUND: Although patients with acute myeloid leukemia (AML) were shown to have an increased risk of thrombosis, no thrombosis risk assessment scoring system has been developed for AML patients. The Khorana Risk Score (KRS), which has been widely used for thrombosis risk assessment in the clinical setting, was developed on the basis of solid tumor data and has not been validated among AML patients. This study aims to validate the use of the KRS as a thrombosis risk-scoring system among patients with AML. METHODS: Using data from H. Lee Moffitt Cancer Center and Research Institution's Total Cancer Care Research Study, we retrospectively identified patients who were histologically confirmed with AML from 2000 to 2018. Clinical and laboratory variables at the time of AML diagnosis were characterized and analyzed. The thrombotic event rate was estimated with the Kaplan-Meier method and compared using the log-rank test. RESULTS: A total of 867 AML patients were included in the analysis. The median age at AML diagnosis was 75 years (range, 51-96), and the majority were male (65%, n = 565). A total of 22% (n = 191), 51% (n = 445), 24% (n = 207), and 3% (n = 24) of patients had a KRS of 0, 1, 2, and 3, respectively. A total of 42 thrombotic events (3% [n = 6/191] with a KRS of 1; 5% [n = 23/445] with a KRS of 2; 6.3% [n = 13/207] with a KRS of 3) were observed, with a median follow-up of 3 months (range, 0.1-307). There was no statistical difference in the risk of thrombosis between these groups (P = .1949). CONCLUSIONS: Although there was an increased risk of thrombosis associated with a higher KRS among AML patients with a KRS of 1 to 3, the difference was not statistically significant. Furthermore, only a few patients were found to have a KRS > 3, and this was largely due to pancytopenia, which is commonly associated with AML. These results indicate the need for a better thrombotic risk-scoring system for AML patients.
RESUMO
Background: Mineral oil injection represents a dated practice of rapid and inexpensive breast augmentation. After a latency period, surrounding tissue becomes inflamed and fibrotic. Breast paraffinoma is well-documented in women; however, only 3 cases of such masses in male patients exist in the literature. Methods: We present a case of paraffinoma in a 63-year-old man from Puerto Rico who, desiring breasts, serially injected mineral oil into each breast daily for 13 years. Conservative management was initially attempted due to cardiac comorbidities and insurance authorization issues. The patient ultimately developed erosive wounds and therefore underwent excision of the bilateral breast masses as an en bloc specimen weighing 2.17 kg. Results: Pathology indicated sclerosing lipogranulomatosis (paraffinoma). The quality of the wounds remaining warranted negative pressure wound therapy with serial debridement. The patient went on to successful reconstruction with a reverse abdominoplasty preserving periumbilical and intercostal perforators. Conclusions: Plastic surgeons must educate patients against using exogenous injected materials for augmentation of the breasts, penis, or buttocks. Although uncommon in the US, certain populations like body builders and foreign immigrants are at higher risk for current or prior injection practices. Reverse abdominoplasty is a viable reconstructive modality for the large resulting defect.