Primary malignant melanoma of the jejunum. A case report

BackgroundMalignant melanomas in the small intestine are commonly encountered as the metastases from primary cutaneous lesions. Even though it’s rare, it can also develop as a primary mucosal tumour in the gastrointestinal tract. We present a rare case of primary jejunal melanoma.Case presentationA 72-year-old male was investigated for occult gastrointestinal bleeding following three consecutively positive stool occult blood tests and his haematological investigations showed that severe iron deficiency anaemia. Upper gastrointestinal endoscopy and colonoscopy did not revealed any abnormality. Capsular endoscopy was performed and found to have a distal jejunal lesion with ulceration, bleeding and blackish discolouration. It was unsuccessful, even though we attempted single balloon enteroscopy to reach the site to obtain a biopsy and following contrast enhanced CT of the abdomen and pelvis the distal jejunal mass was confirmed with no abnormality found in the rest of the study. Since the CT further revealed that it was approximately 5 cm tumour arising from the jejunal wall and growing in to the lumen of the jejunum, Ultra sound guided Fine needle aspiration cytology attempted and found to have a blackish pigmented aspiration and later it was confirmed melanin pigment rich aspirate during the cytological examination. The mass was confirmed on laparotomy and histologically diagnosed as melanoma. Extensive postoperative clinical examination revealed no cutaneous lesions. Following the curative resection the patient recovered uneventfully.ConclusionsPrimary intestinal malignant melanoma in jejunum is an extremely rare occurrence. Complete surgical resection is the treatment of choice. The lymph node metastasis have the worse prognosis. 

STAT3: A Promising Therapeutic Target in Multiple Myeloma

10.3390/cancers11050731CANCERS11

Tumor-Associated Macrophages and Related Myelomonocytic Cells in the Tumor Microenvironment of Multiple Myeloma

10.3390/cancers14225654CANCERS142

Immunotherapy in Multiple Myeloma

10.3390/cells9030601CELLS9

Immunotherapy in Multiple Myeloma

Multiple myeloma is a complex disease and immune dysfunction has been known to play an important role in the disease pathogenesis, progression, and drug resistance. Recent efforts in drug development have been focused on immunotherapies to modify the MM disease process. Here, we summarize the emerging immunotherapies in the MM treatment landscape

Favipiravir in Covid-19

The SARS-Cov-2 virus, emerged in December 2019 in Wuhan, China and has now spread to all parts of the world. Many research groups are carrying out intense research on drugs and vaccines to treat or prevent Covid-19. We have outlined aspects relating to Favipiravir, in treating RNA viral infections and its potential role in controlling SARS-Cov-2 infections

Tumor-Associated Macrophages and Related Myelomonocytic Cells in the Tumor Microenvironment of Multiple Myeloma

Multiple myeloma (MM) is the second-most common hematologic malignancy and remains incurable despite potent plasma cell directed therapeutics. The tumor microenvironment (TME) is a key player in the pathogenesis and progression of MM and is an active focus of research with a view to targeting immune dysregulation. Tumor-associated macrophages (TAM), myeloid derived suppressor cells (MDSC), and dendritic cells (DC) are known to drive progression and treatment resistance in many cancers. They have also been shown to promote MM progression and immune suppression in vitro, and there is growing evidence of their impact on clinical outcomes. The heterogeneity and functional characteristics of myelomonocytic cells in MM are being unraveled through high-dimensional immune profiling techniques. We are also beginning to understand how they may affect and be modulated by current and future MM therapeutics. In this review, we provide an overview of the biology and clinical relevance of TAMs, MDSCs, and DCs in the MM TME. We also highlight key areas to be addressed in future research as well as our perspectives on how the myelomonocytic compartment of the TME may influence therapeutic strategies of the future

Implications of Heterogeneity in Multiple Myeloma

Multiple myeloma is the second most common hematologic malignancy in the world. Despite improvement in outcome, the disease is still incurable for most patients. However, not all myeloma are the same. With the same treatment, some patients can have very long survival whereas others can have very short survival. This suggests that there is underlying heterogeneity in myeloma. Studies over the years have revealed multiple layers of heterogeneity. First, clinical parameters such as age and tumor burden could significantly affect outcome. At the genetic level, there are also significant heterogeneity ranging for chromosome numbers, genetic translocations, and genetic mutations. At the clonal level, there appears to be significant clonal heterogeneity with multiple clones coexisting in the same patient. At the cell differentiation level, there appears to be a hierarchy of clonally related cells that have different clonogenic potential and sensitivity to therapies. These levels of complexities present challenges in terms of treatment and prognostication as well as monitoring of treatment. However, if we can clearly delineate and dissect this heterogeneity, we may also be presented with unique opportunities for precision and personalized treatment of myeloma. Some proof of concepts of such approaches has been demonstrated

Atypical lymphocyte count correlates with the severity of dengue infection.

IntroductionThe early identification of patients at risk of severe dengue infection (DI) is critical to guide clinical management. There is currently no validated laboratory test which can predict severe complications of DI. The Atypical lymphocyte count (ALC) is a research parameter generated at no extra cost when an automated Full Blood Count (FBC) is performed. The purpose of this study was to assess the association of ALC with the severity of DI.MethodsWe prospectively collected data on patients admitted to Nawaloka Hospital Sri Lanka (NH) with DI between December 2016 and November 2017. DI was diagnosed based on a positive Non-structural antigen 1 (NS1) or dengue IgM antibody. ALC (absolute ALC and percentage) data were extracted from the Sysmex XS500i automated full blood count (FBC) analyzer (Sysmex Corporation Kobe, Japan). Clinical data was recorded from medical records and the computerized data base maintained by NH.Results530 patients were enrolled. Patients with clinical manifestations of severe dengue have a significantly higher AL % compared to dengue without warning signs. Patients who presented with respiratory compromise had statistically significantly higher AL% compared to those without. (AL%; 8.65±12.09 vs 2.17±4.25 [p = 0.01]). Similarly, patients who developed hypotension had higher AL% compared to those who did not suffered from shock (AL%; 8.40±1.26 vs 2.18±4.25 [p = 0.001]). The AL% of dengue patients presenting with bleeding, at 4.07%, is also higher than those without bleeding complications, at 2.15%. There was a significant negative association between platelet count and AL% (p = 0.04).ConclusionsClinical manifestations of severe dengue have a significantly higher AL % compared to dengue without warning signs. AL % at presentation may be predictive of severe DI and future larger prospective longitudinal studies should be done to determine if AL % on admission is predictive of the complications of DI

Atypical lymphocyte count correlates with the severity of dengue infection

10.1371/journal.pone.0215061PLOS ONE14