Acute Myeloid Leukemia Presenting as Granulocytic Sarcoma (Chloroma) of the Tongue: A Case Report

Chloroma or Granulocytic Sarcoma or Myeloid Sarcoma or Myeloblastoma is a tumor composed of immature myeloid precursor cells or blasts. It is an extra medullary manifestation of AML, which is extremely rare but well documented. It can herald, follow or occur with a diagnosis of primary AML. It can also be seen in relapse [1]. The usual sites of involvement are skin, soft tissue and lymph nodes. Intra oral myeloid sarcoma is infrequent and particularly chloroma in the tongue is further uncommon. A thorough review of literature yielded only three reported cases of chloroma of the tongue [2-4]. In this case report, we describe a case of a 36-year-old female who presented with two weeks of dysphagia due to a large tongue lesion accompanied by pancytopenia. The tongue lesion was strongly suspicious of a chloroma. Bone marrow biopsy confirmed a diagnosis of AML and a resolution of the chloroma was observed with induction chemotherapy for AML

Malignant Gastric PEComa: A Rare Malignancy

Introduction: Perivascular epithelioid cell tumor (PEComa) is characterized by its perivascular location and spindle appearance of tumor cells with clear to lightly granular eosinophilic cytoplasm and a round-to-oval centrally located nucleus. Immunohistochemically, nearly all PEComas show reactivity for melanocytic (HMB-45 and/or melan-A) and smooth muscle (actin and/or desmin) markers. Malignant gastric PEComa is extremely rare and only 3 cases have been reported to best of our knowledge. We report a 4th case of malignant gastric PEComa.Case presentation: We are presenting a case of a 48 year-old Caucasian female who presented to the emergency department with complaint of abdominal pain for 3-4 weeks associated with intermittent nausea and vomiting. CT Abdomen/Pelvis with contrast showed a mass at the greater curvature of the distal stomach. Patient underwent resection of the mass and pathology result was consistent with malignant PEComa.Conclusion: PEComas are a family of rare mesenchymal tumors, composed of histologically and immunohistochemically distinctive perivascular epithelioid cells. These tumors co-express, the muscle and melanotic markers. Surgical resection is the best treatment option. Most commonly, they arise in the retroperitoneum and colon is most the common site followed by small intestine in the GI tract

Role of Non-Selective Beta Blockers in Hepatocellular Carcinoma: An Analysis in Patients with Cirrhosis and Portal Hypertension

There are many different biochemical processes responsible for the hepatocelluar carcinoma (HCC) development that can be targeted for the prevention or halt progression of the HCC. Non-selective betablockers (NSBB) affects a multitude of intracellular biochemical and signaling pathways involved in carcinogenesis. Aim: To determine if NSBB may be protective for HCC in patients with cirrhosis and portal hypertension. Methods: We retrospectively enrolled 200 patients from medical records diagnosed with cirrhosis and portal hypertension between January 2001 and December 2013. Eighteen patients were excluded (taking selective beta-blocker and/or unavailable medical records). The etiology of cirrhosis, use of NSBB, demographics and the presence of HCC was collected. Result: There were 140 males and 42 females. The mean age for portal hypertension with cirrhosis without HCC was 53.5 ± 11.4 & with HCC was 62.2 ± 9.5 years. Univariate analysis of the association of NSBB with HCC yielded OR = 0. 11 (95% CI: 0.04 to 0.25); p \u3c 0.0001, suggesting a protective effect of NSBB. Multivariable analysis suggests virtually no change when the Odds ratio (OR) was adjusted for diabetes mellitus (DM), alcohol use, Hepatitis B virus (HBV) status, Black race and age ≥ 53. There was a slight increase in the OR adjusted for statin use. Conclusion: This study highlights association of NSBB use in the patients with liver cirrhosis and portal hypertension for prevention of HCC

Hyperleukocytosis during clozapine treatment: A rare presentation of B-cell Acute lymphoblastic leukemia

Clozapine has been widely used as an antipsychotic drug for the treatment of refractory schizophrenia. Unfortunately, a wide range of blood dyscrasias have been reported as adverse effects of this drug. Agranulocytosis has gotten the most clinical vigilance; however, there are substantial reports of other blood dyscrasias associated with Clozapine some more serious than others. Of relevance, there have been previous claims of Clozapine-associated leukocytosis and acute myeloid leukemia. We report the case of a 31-year-old patient who developed Acute lymphoblastic leukemia shortly after starting treatment with Clozapine for refractory schizophrenia. We suggest Clozapine may play a causal role in the development of leukemias in patients taking this medication and we encourage vigilance for such correlation

Autoimmune Hepatitis–Primary Biliary Cholangitis Overlap Syndrome Triggered by COVID-19

COVID-19, caused by severe acute respiratory syndrome coronavirus 2 infection, has caused the ongoing global pandemic. Initially considered a respiratory disease, it can manifest with a wide range of complications (gastrointestinal, neurological, thromboembolic and cardiovascular) leading to multiple organ dysfunction. A range of immune complications have also been described. We report the case of a 57-year-old man with a medical history of hypertension, prediabetes and beta thalassemia minor, who was diagnosed with COVID-19 and subsequently developed fatigue and arthralgias, and whose blood work showed hyperferritinemia, elevated liver enzymes (AST/ALT/GGT), hypergammaglobulinemia, anti-smooth muscle antibody, anti-mitochondrial antibody, and anti-double-stranded DNA antibodies. The patient was diagnosed with autoimmune hepatitis–primary biliary cholangitis overlap syndrome triggered by COVID-19. To our knowledge, this is the first such case reported

Unforeseen Hodgkin Lymphoma Hidden behind Hypercalcemia

As one of the leading causes of hypercalcemia, malignancy is an essential consideration when patients present with such symptomology. While certain tumors are more known to cause hypercalcemia, it can occur with almost any type of cancer. Hodgkin lymphoma is an infrequent cause of hypercalcemia. Only a few case reports have been published in the literature to date. We report an unusual case of a 61-year-old female who presented with altered mental status, nausea, vomiting, and dizziness and was found to have multiple enlarged lymph nodes, and blood work showed hypercalcemia. Biopsy of the cervical lymph node showed Hodgkin lymphoma of the nodular sclerosis subtype. Our case aims to raise awareness of this rare but significant presentation of hypercalcemia and how timely treatment of calcium levels can facilitate the employment of available chemotherapeutic options

Hemophagocytic lymphohistiocytosis presenting as acute coronary syndrome

Acquired Hemophagocytic Lymphohistiocytosis is a rare and deadly syndrome resulting from an overactive immune system, with uncontrolled activation of macrophages and lymphocytes, hypercytokinemia, and systemic inflammatory response. A 75-year-old male presented with typical anginal pain and was diagnosed with the acute coronary syndrome, which required a percutaneous transluminal coronary angioplasty. Instead of resolving the symptoms, the patient began to exhibit pyrexia and worsening altered sensorium with progressing renal failure, anemia, thrombocytopenia and respiratory failure. This constellation of symptoms caused the patient to require mechanical ventilation and hemodialysis. Upon laboratory analysis, hyperferritinemia provided an indication to the diagnosis of acquired hemophagocytic lymphohistiocytosis. After the initiation of dexamethasone, the patient made a significant recovery and was discharged from the hospital