Plasmablastic lymphoma of the maxillary sinus in an HIV-negative patient: a case report and literature review

Plasmablastic lymphoma (PBL) is a rare and aggressive variant of diffuse large B cell lymphoma. The prognosis of PBL patients is poor. The majority of patients succumb to a fulminant disease course, with most dying in the first year after diagnosis. The small number of HIV-negative PBL cases reported in the literature to date is composed of single case reports and small case series. Consequently, the natural history of the disease in HIV-negative individuals and the optimum treatment are not well characterized. Intensive induction chemotherapy has been associated with marked improved overall survival. However the optimal regimen has not been defined. We describe the third case of PBL of the maxillary sinus which occurred in a 24-year old HIV-negative man. We outline the clinicopathological features and report success using a hyper-CVAD regimen with 6 cycles and consolidation radiation therapy yielding a complete remission of four years

Clinical Characteristics and Treatment-Related Biomarkers Associated with Response to High-Dose Interleukin-2 in Metastatic Melanoma and Renal Cell Carcinoma: Retrospective Analysis of an Academic Community Hospital\u27s Experience.

Background Immunotherapy in the treatment of metastatic melanoma and renal cell carcinoma can produce durable therapeutic responses, which may improve survival. We aimed to identify clinical characteristics and biomarkers associated with response to high-dose interleukin-2 therapy (IL-2) in patients with metastatic melanoma and renal cell carcinoma treated at an academic community hospital. Patients/Methods We retrospectively analyzed clinical variables and biomarkers of 50 consecutive metastatic melanoma or renal cell carcinoma patients treated at our institution with IL-2 during 2004 – 2012. We evaluated clinical characteristics: metastatic sites of disease, prior therapies, number of IL-2 doses per cycle, response duration, autoimmune phenomena, and peak fever, as well as laboratory biomarkers: baseline LDH, platelet nadir, and baseline and highest absolute lymphocyte count (ALC). Survival outcomes were calculated using Kaplan-Meier curves. Results Variables differing between responders (clinical benefit group) and non-responders (no clinical benefit group) in metastatic melanoma included platelet nadir during treatment (p = 0.015), autoimmune phenomena (p = 0.049), and in renal cell carcinoma, platelet nadir (p = 0.026). There were no significant differences between number of doses of IL-2 received per cycle and response in either cancer subtype. Clinical benefit occurred in 25% of patients (9/36) when IL-2 was given as first-line therapy. Median overall survival for the clinical benefit group from the initiation of IL-2 to death or last follow-up was 61 months versus 17 months for the no clinical benefit group (p \u3c 0.001) for metastatic melanoma. In renal cell carcinoma overall survival for clinical benefit patients was 48 months versus 17 months. No treatment-related deaths occurred. Conclusions High-dose IL-2 can be safely administered by an experienced team in a non–intensive care oncology unit. The clinical benefit group developed autoimmune phenomena (melanoma patients), lower platelet nadir, and on average, received the same number of IL-2 doses as the no clinical benefit group, suggesting a response relationship to the patient’s baseline immune status. Further investigation of immune predictors of response may be useful to select appropriate patients for this therapy. Keywords: Interleukin-2, Metastatic melanoma, Metastatic renal cell carcinoma, IL-2, Biomarkers, Safety, Respons

Effects of glucagon-like peptide-1 and long-acting analogues on cardiovascular and metabolic function.

Although the insulinotropic role of glucagon-like peptide-1 (GLP-1) in type 2 diabetes mellitus has been substantiated, its role in cardioprotection remains largely unknown. To ascertain the role of the cardiovascular actions of GLP-1 in health and disease states necessitates a review of the current evidence as well as ongoing investigation. Of cardiovascular significance, both positive inotropic and chronotropic effects, unmodifiable by beta-adrenergic blockers, have been reportedly attributed to GLP-1 actions on the myocardium. However, the potent role of GLP-1 and its analogues in eliciting tachycardic and pressor effects should be of some concern. Aside from its reported insulinotropic activity, GLP-1 impacts the myocardium directly. Highly specific GLP-1 receptors have been identified in the heart and within the central nervous system, particularly in the nucleus tractus solitarius, a neuromodulatory centre of cardiovascular control. The occurrence of GLP-1 receptors in cardiac tissue and autonomic regions of cardiovascular control has stimulated investigation, particularly as these sites may be suitable targets for the pharmacological action of GLP-1 and long-acting analogues. Discordance on the haemodynamic consequences of GLP-1 pharmacotherapy in experimental animals and human patients has been reported in the literature. However, long-term pharmacological doses of GLP-1 have shown prolonged and beneficial actions on cardiovascular homeostasis in the adjuvant treatment of metabolic disease

Pneumococcal Sepsis-Induced Purpura Fulminans in an Asplenic Adult Patient Without Disseminated Intravascular Coagulation

Acute perturbations in the hemostatic balance of anticoagulation and procoagulation antecede the manifestation of purpura fulminans, a rare syndrome of intravascular thrombosis and hemorrhagic infarction of the skin. Hallmarks include small vessel thrombosis, tissue necrosis and disseminated intravascular thrombosis. The course may be rapidly fulminant resulting in multiorgan failure with thrombotic occlusion of the vasculature, leading to distal extremity ischemia and necrosis. Depletion of protein C (PC) has been emphasized in the pathogenesis. Early intravenous antibiotic administration and hemodynamic support are cornerstones in management. Herein, we report a case of pneumococcal sepsis-induced purpura fulminans limited to the skin in an asplenic adult patient without the development disseminated intravascular coagulation

Spinal meningioma: chronicles of contemporary neurosurgical diagnosis and management.

Spinal meningiomas are uncommon entities that fortunately burden only a small minority of patients. Notwithstanding their overwhelmingly benign propensity, the occurrence of extramedullary meningioma may nonetheless cause significant morbidity and possible mortality. The consideration therefore, of spinal meningioma in the differential of patients presenting with radiculopathy or complaints of chronic back or neck pain should not be disregarded. The rapidity of diagnosis and the first neurosurgical encounter are cornerstones in patient longevity and neurological preservation. The advent of microsurgical techniques and magnetic resonance imaging and surgical techniques has notably improved clinical outcomes over the past two decades. However, surgical candidacy may be limited, particularly in those patients with significant preexisting medical comorbidities, aggressive or recurring tumors, or multiple lesions. Alternative management strategies such as stereotactic radiosurgery or less invasive surgical techniques are currently underway in clinical practice. A review on neurosurgical diagnosis and treatment modalities in the management of spinal meningioma is therefore pertinent

Cardiac and metabolic consequences of aerobic exercise training in experimental diabetes.

The experimental literature of the foregoing decade has furnished an assemblage of mechanisms explaining the metabolic perturbations and overall decline in cardiac performance implicated in the pathogenesis of diabetes mellitus. Particularly, the experimentally-induced diabetic rat model has been indispensable in the examination of diabetic cardiomyopathy, an entity distinctly separable from atherosclerosis, hypertension, coronary artery disease and valvular dysfunction, yet convincingly attributable to the increase in cardiac-associated mortality commonly observed in the diabetic patient. The widespread epidemic of diabetes mellitus in developed societies has elicited considerable attention and the role of exercise as an adjuvant therapy in diabetes management has been increasingly emphasized. However, the evidence endorsing the beneficial attributes of exercise in the diabetic state is indeterminate despite markedly observed increases in myocardial and skeletal muscle glucose homeostasis, endothelial and autonomic function, insulin sensitivity and amelioration of diabetes pathogenesis. As evidenced by review of the experimental literature, a mild to moderately intense exercise regime may be a reliably implicated insulin-sensitizing therapy for the experimentally-diabetic rat model as well as the human diabetic patient. Notably, the cardio-protective and metabolic benefits of aerobic exercise are seemingly more pronounced in those individuals most susceptible to diabetes progression

Extracranial radiosurgery--applications in the management of benign intradural spinal neoplasms.

Stereotactic radiosurgery has enabled the delivery of higher doses of radiation and decreased fractionation due to improved accuracy. Spinal radiosurgery has been increasingly utilized for the management of metastatic extradural spinal disease. However, surgical resection remains the primary treatment strategy for intradural spinal tumors. Preliminary evidence suggests that radiosurgical ablation with stereotactic radiation for intradural spinal lesions may be efficacious in certain clinical scenarios. Local tumor control, pain relief, and improvement in neurologic function with minimal morbidity have been reported in short-term follow-up. However, long-term efficacy of radiosurgery in the management of intradural spinal neoplasms necessitates further validation. As extracranial radiosurgery is a newly evolving modality, a continuative review of the current literature is appropriate. Until a standardized therapeutic window of safety and efficacy can be determined, the recommendation of radiosurgical applications for benign spinal tumors should be reserved for carefully selected cases

Primary Dural Lymphoblastic B-Cell Lymphoma: A Rare Subtype of Aggressive Dural Lymphoma.

Lymphomas arising in the dura mater represent a rare subset of primary central nervous system lymphoma (PCNSL). The majority of primary dural lymphoma (PDL) are low-grade marginal zone lymphomas (MZL) characterized by an indolent course and favorable long-term outcomes. Primary aggressive dural lymphomas are exceedingly rare with a paucity of cases reported in the literature. Herein, we describe a case of primary lymphoblastic dural lymphoma. To our knowledge, this is the second report of an isolated dural B-lymphoblastic lymphoma (B-LBL) in an immunocompetent patient