In case of unresectable or metastatic gastric cancer, though many trials have been going, treatment results are poor yet. We report a patient with peritoneal metastasis from gastric cancer effectively treated with docetaxel and cisplatin chemotherapy. The patient was a 33 year-old man who was confirmed poorly differenciated adenocarcinoma of stomach 5 years ago. At the diagnosis, the stage of gastric cancer was T2N3M0. He underwent subtotal gastrectomy with Billoth II anastomosis and 6th cycles of postoperative adjuvant chemotherapy consisting of FAMTX. After that, there was no evidence of recurrence. Three years later, he was admitted to our hospital complaining of abdominal pain and distension. Abdominal CT revealed that recurred gastric cancer in anastomotic site with carcinomatous peritonei and multiple lymphadenopathy. He was performed chemotherapy combined with docetaxel (75 mg/m2) and cisplatin (75 mg/m2). After 3rd chemotherapy, follow up abdominal CT showed nearly complete regression of bowel loops, lymph node and ascites. After completion of 7th cycles of chemotherapy, it remained as complete response for recurred gastric cancer and he has no evidence of recurrence for over 2 years.
Abdominal Pain ; Adenocarcinoma ; Adult ; Ascites ; Chemotherapy, Adjuvant ; Cisplatin* ; Diagnosis ; Drug Therapy* ; Follow-Up Studies ; Gastrectomy ; Humans ; Lymph Nodes ; Lymphatic Diseases ; Neoplasm Metastasis* ; Peritoneal Neoplasms ; Recurrence ; Stomach ; Stomach Neoplasms* ; Tomography, X-Ray Computed

BACKGROUND: The automated hematologic analyzer has increased the precision and accuracy for platelet counting. However, spurious elevations of automated platelet counts occur occasionally in patients receiving chemotherapy or radiotherapy for solid organ tumors, leukemia, and other lymphomas. The CELL-DYN Sapphire analyzer (Abbott, USA) detects platelets with a CD61 monoclonal antibody and uses both impedance and optical technologies; thus, it is expected to present more accurate platelet counts. METHODS: We evaluated platelet counts obtained with the CELL-DYN Sapphire impedance, optical, and CD61 methods and compared them with the results obtained with the XE-2100 analyzer (Sysmex, Japan). We analyzed 111 samples from hospitalized patients with various hematologic diseases, who were receiving chemotherapy or radiotherapy. RESULTS: The results from the impedance, optical, and CD61 methods of CELL-DYN Sapphire and those from XE-2100 showed significant linearity, with correlation coefficients greater than 0.99. Three cases had significantly different platelet counts among the different methods used. Microscopic examination of these three cases showed very low platelet counts that corresponded with the low counts from the CD61 methods. It should be noted that because the automated blood counter assesses cell populations by their dimensions, many cellular fragments that were of the same size or smaller than platelets were thus counted as platelets. CONCLUSIONS: The CELL-DYN Sapphire analyzer has good precision, linearity and performance, comparable with the XE-2100 analyzer. As the CD61 methods of CELL-DYN Sapphire is specific for platelet, this method may reduce the interference from other blood components and count the exact platelet numbers.
Aluminum Oxide* ; Blood Platelets ; Drug Therapy* ; Electric Impedance ; Hematologic Diseases* ; Humans ; Leukemia ; Lymphoma ; Platelet Count* ; Radiotherapy

Chromosome 13q deletion syndrome, which is relatively rare, is characterized by a wide spectrum of phenotypes resulting from a partial deletion of the long arm of the chromosome 13. The main clinical features are mental retardation, developmental delay, craniofacial dysmorphism, and various congenital defects. Here, we report a de novo interstitial deletion in chromosome 13 (q21.3q31) in a neonate with congenital megacolon (Hirschsprung disease) confirmed by biopsy. A short tandem repeat analysis (D13S317) was used to compare the loci on the chromosomes of the patient and the parents, the latter representing the normal karyotype, to determine how the features of the profile peaks relate to the deletion. The clinical data were also compared with those of similar cases in previously published reports.
Arm ; Biopsy ; Chromosome Deletion ; Chromosome Disorders ; Chromosomes, Human, Pair 13 ; Congenital Abnormalities ; Hirschsprung Disease ; Humans ; Infant, Newborn ; Intellectual Disability ; Karyotype ; Megacolon ; Microsatellite Repeats ; Parents ; Phenotype ; Polymethacrylic Acids

Clostridium difficile, an anaerobic, spore-forming, gram-positive, rod-shaped bacterium, is the most common nosocomial pathogen causing pseudomembranous colitis. C. difficile is not intrinsically invasive and rarely infects extraintestinal sites. The bacterium, therefore, is not commonly detected in blood cultures. Here, we report a case of C. difficile bacteremia in a patient who had underwent loop ileostomy because of rectal obstruction following metastatic colon cancer originated from prostate cancer.
Anti-Bacterial Agents/*therapeutic use ; Bacteremia/*drug therapy ; Clostridium difficile/genetics/*isolation & purification ; Colonic Neoplasms/pathology/secondary ; Enterocolitis, Pseudomembranous/drug therapy/microbiology ; Humans ; Ileostomy ; Male ; Middle Aged ; Prostatic Neoplasms/pathology ; RNA, Ribosomal, 16S/chemistry/genetics ; Sequence Analysis, RNA

Clostridium difficile, an anaerobic, spore-forming, gram-positive, rod-shaped bacterium, is the most common nosocomial pathogen causing pseudomembranous colitis. C. difficile is not intrinsically invasive and rarely infects extraintestinal sites. The bacterium, therefore, is not commonly detected in blood cultures. Here, we report a case of C. difficile bacteremia in a patient who had underwent loop ileostomy because of rectal obstruction following metastatic colon cancer originated from prostate cancer.
Anti-Bacterial Agents/*therapeutic use ; Bacteremia/*drug therapy ; Clostridium difficile/genetics/*isolation & purification ; Colonic Neoplasms/pathology/secondary ; Enterocolitis, Pseudomembranous/drug therapy/microbiology ; Humans ; Ileostomy ; Male ; Middle Aged ; Prostatic Neoplasms/pathology ; RNA, Ribosomal, 16S/chemistry/genetics ; Sequence Analysis, RNA

DNA methyltransferase inhibitor, 5-azacitidine (AC) is effective in myelodysplastic syndromes (MDS) and can induce re-expression in cancer. We analyzed the methylation of 25 tumor suppressor genes in AC-treated MDS. Hypermethylation of CDKN2B, FHIT, ESR1, and IGSF4 gene was detected in 9/44 patients. In concordance with the clinical response, a lack of or decreased methylation in 4 patients with hematologic improvements and persistent methylation in 4 others with no response was observed. The mRNA expression of CDKN2B, IGSF4, and ESR1 was significantly reduced in MDS. Our results suggest that methylation changes contribute to disease pathogenesis and may serve as marker to monitor the efficacy of treatments.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Azacitidine/*pharmacology/*therapeutic use ; DNA Methylation/*drug effects ; DNA Modification Methylases/antagonists & inhibitors/metabolism ; Enzyme Inhibitors/*pharmacology/*therapeutic use ; Female ; Genes, Tumor Suppressor ; Humans ; Male ; Middle Aged ; Myelodysplastic Syndromes/*drug therapy/*genetics ; Young Adult

BACKGROUND: A change in urine output has been recently recognized as a valuable biomarker of acute kidney injury that is associated with mortality in critically ill patients. We investigated the prognostic impact of oliguria for survival outcomes in multiple myeloma (MM) patients presenting with renal impairment (RI). METHODS: Retrospective data on 98 patients with MM and RI, who received initial treatment with novel therapies, were analyzed. Oliguria was defined as a urine output of <0.5 mL/kg/h. RESULTS: The baseline median eGFR was 39.7 mL/min (range, 5.1-59.8). Achievement of renal complete response (CR) was observed in 39.8% of patients. Nine patients (9.2%) presented with oliguria at initial diagnosis, and 4 initially required dialysis. Over a median follow-up period of 17.1 months (range, 1.7-100.0), the median overall survival (OS) was 38.7 months (95% CI 25.0-52.5). Multivariate analyses indicated that oliguria at diagnosis [hazard ratio (HR) 3.628, 95% CI 1.366-9.849, P=0.011], and thrombocytopenia <100x10(9)/L at diagnosis (HR 2.534, 95% CI 1.068-6.015, P=0.035), were significantly associated with overall survival. CONCLUSION: Oliguria was significantly associated with higher mortality in MM patients with RI. Therefore, close monitoring of urine output could be important for these patients.
Acute Kidney Injury ; Critical Illness ; Diagnosis ; Dialysis ; Follow-Up Studies ; Humans ; Mortality* ; Multiple Myeloma* ; Multivariate Analysis ; Oliguria* ; Renal Insufficiency ; Retrospective Studies ; Thrombocytopenia

The diagnosis of incracranial tuberculoma in immune-compromised hosts is often difficult because conventional magnetic resonance (MR) imaging of tuberculoma reveals various findings and neurologic symptoms are not typical. Here, we report a case of a 54-yr old man with multiple intracranial tuberculoma who was treated for acute myeloid leukemia. He complained of right-side paresthesia after the third consolidation chemotherapy without leukemic relapse and fever. MR imaging of the brain showed multiple ring-enhanced lesions in the cerebrum, cerebellar hemisphere, and pons. The lesions appeared to mimic a metastatic tumor or abscess. Cerebrospinal fluid analysis showed no abnormal cells, but the level of adenosine deaminase was elevated (28.8 IU/L, normal 0-8). Stereotactic brain biopsy was performed, but only reactive gliosis was observed. To confirm diagnosis, an open brain biopsy was performed. The histopathology demonstrated chronic granulomatous inflammation with caseous necrosis. Tuberculous-polymerase chain reaction of the biopsy showed a positive result. He was treated with anti-tuberculosis medication and a high dose of steroid. Paresthesia improved, and follow-up brain MR imaging showed the decreased size and numbers of ring-enhanced lesions and improvement of perilesional edema 1 month after treatment. Here, we report on an interesting case of intracranial tuberculoma in acute myeloid leukemia.
Antitubercular Agents/therapeutic use ; Brain Neoplasms/*diagnosis ; Diagnosis, Differential ; Humans ; Leukemia, Myeloid, Acute/*complications ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Sarcoma, Myeloid/*diagnosis ; Tuberculoma, Intracranial/complications/*diagnosis/drug therapy

BACKGROUND: Eltrombopag is a thrombopoietin receptor agonist with excellent treatment outcomes in immune thrombocytopenia (ITP). Here, we analyzed the dose of eltrombopag required to achieve and maintain safe platelet counts in Korean ITP patients. METHODS: Adult refractory ITP patients (<30,000 platelets/microL) were enrolled. Eltrombopag doses were increased to achieve a target platelet count (> or =50,000 cells/microL). After achieving the target platelet count, the dose of concomitant ITP medications and eltrombopag was reduced to identify the lowest effective dose required to maintain the platelet count. RESULTS: Among 18 patients, 66.7% achieved complete response, 5.6% achieved platelet counts between 50,000 and 100,000 cells/microL, and 27.8% failed to achieve the target platelet count. The median ITP duration was significantly shorter in patients who achieved the target platelet count. The initial dose required to achieve the target platelet count was 25 mg/d. The adjusted maintenance doses were 25 mg twice per week or 25 mg/d. After discontinuation, 83.3% relapsed, and the median relapse-free survival was 15 days. Two relapsed and 1 failed patient switched to romiplostim. The response to romiplostim was similar to eltrombopag. During eltrombopag treatment, 38.9% showed hepatobiliary laboratory anomalies. Among 9 follow-up bone marrow examinations, 1 revealed fibrosis after 1 year of treatment. CONCLUSION: Eltrombopag was well tolerated with excellent treatment outcomes in refractory adult ITP patients. Low-dose eltrombopag effectively maintained the target platelet count. However, some patients required longer or higher-dose treatment to maintain the target platelet count, especially in heavily pretreated or longer ITP cases.
Adult* ; Bone Marrow Examination ; Fibrosis ; Follow-Up Studies ; Humans ; Platelet Count ; Purpura, Thrombocytopenic, Idiopathic ; Receptors, Thrombopoietin ; Thrombocytopenia*

Generalized granuloma annulare (GGA) is a rare variant of granuloma annulare, presenting with diffuse papules and annular patches on the trunk and extremities. Though the pathogenesis of GGA has not been totally understood, recent studies have shown the relationship between malignancy and GGA. A 74-year-old man developed a generalized, mildly pruritic erythematous papules, which slowly coalesced into annular patch with elevated rim. Punch biopsy showed palisading and interstitial granuloma with giant cells. A complete blood cell count with differential revealed leukopenia and subsequent findings of the bone marrow biopsy were compatible with myelodysplastic syndrome (MDS). As there was no more progression of MDS, only the skin lesions were treated with hydroxychloroquine, isotretinoin and phototherapy, and improved after 14 months of treatment. We recommend that careful evaluation of the underlying solid tumor, as well as hematologic malignancy, should be done when the dermatologists encounter with the patient presenting generalized granuloma annulare.
Aged ; Biopsy ; Blood Cell Count ; Bone Marrow ; Extremities ; Giant Cells ; Granuloma ; Granuloma Annulare ; Hematologic Neoplasms ; Humans ; Hydroxychloroquine ; Isotretinoin ; Leukopenia ; Myelodysplastic Syndromes ; Phototherapy ; Skin