Lentigines are brown macules which represent increased proliferation of melanocytes at the dermo-epidermal junction. We report three cases of acral lentiginosis in children following chemotherapy for acute lymphoblastic leukaemia (ALL) which have persisted following cessation of chemotherapy, despite avid photoprotection.
Statins are widely prescribed and well tolerated with most side effects now considered a nocebo effect. Occasionally, statins can be associated with immune mediated necrotizing myositis that is both difficult to diagnose and treat. Aggressive immunosuppressive therapy is the best recognized method of treatment of this complication.
Chronic myeloid leukemia (CML) is a myeloproliferative disorder due to translocation between chromosomes (9, 22), known as the “Philadelphia chromosome.” In 2016, the World health organization (WHO) introduced a new clinical entity of de novo acute myeloid leukemia (AML). Both diseases share some commonalities, therefore, create a challenge to diagnose.
Carcinosarcomas are aggressive biphasic neoplasms composed of high-grade, malignant, epithelial, and mesenchymal elements. They usually occur in the uterus and rarely involve the ovaries. Only 10% of them are bilateral. Their diagnosis relies on histological examination coupled with immunohistochemistry.
Detecting fat globules in blood in diagnosing fat embolism syndrome (FES) remains controversial. This case illustrated two life threatening episodes possibly due to FES, with a dramatic increases of fat globules in blood. Significance of quantitative change of fat in blood in diagnosing FES should be evaluated in the future.
Appendiceal diseases are relatively rare reported complications during hematopoietic stem cell transplantation with no guidance on management. Pre- and post-transplant patients should receive a trial of medical therapy with appendectomy after recovery but prior to transplant in the former and plan for appendectomy after completion of immunosuppression in the latter.
We report a rare case of a large prolapsed pedunculated uterine myoma measuring 15cm in its greater diameter. In order to make a surgical procedure safe and feasible, appropriate clinical predictors should be taken into account and pre- and intraoperative preparations be available to the surgeon's armamentarium.
A 33-year-old primiparous woman presented with reduced fetal movements during the gestational age of 33 weeks. Ultrasonography showed a heterogeneous and hypoechoic placental lesion measuring 8 cm. A week later, the patient delivered a live healthy male neonate. Histological examination of the placental mass established the diagnosis of placental chorioangioma.
A 62-year-old otherwise healthy patient was admitted with severe headache for several weeks. Initial imaging studies revealed multiple cystic lesions in both hemispheres. Neuroparasitic infections were considered as primary differential diagnosis. Open biopsy of a right frontal cortical lesion was performed. Pathohistological revealed the diagnosis of cerebral metastasis of adenokarcinoma.
Jejunal mucormycosis in a patient with refractory AMLSamuel De l’Etoile-Morel, MD. McGill University Health Centre. Department of Medicine, Division of Infectious Diseases. 1001 Decarie Blvd, Montreal, Quebec H4A 3J1 Room E05.1811.2.Vladimir Sapon-Cousineau, MD. Department of Medicine, Division of Hematology. 1001 Decarie Blvd, Montreal, Quebec H4A 3J1 Room D02.7731.Dan L. Deckelbaum, MD. McGill University Health Centre. Department of Surgery, Divisions of Trauma and General Surgery. 1650 Cedar Ave, Montreal, Quebec H3G 1A4. L9 425.Michael Sebag, MD McGill University Health Centre. Department of Medicine, Division of Hematology. 1001 Decarie Blvd, Montreal, Quebec H4A 3J1 Room D02.7515.Zu-hua Gao, MD McGill University Health Centre. Department of Clinical Laboratory Medicine, Division of Pathology. 1001 Decarie Blvd, Montreal, Quebec H4A 3J1 Room E04.1820.Vivian G. Loo, MD McGill University Health Centre. Department of Medicine, Division of Infectious Diseases. 1001 Decarie Blvd, Montreal, Quebec H4A 3J1 Room E05.1824.Corresponding author : Samuel De l’Etoile-Morel, MD. McGill University Health Centre. Department of Medicine, Division of Infectious Diseases. 1001 Decarie Blvd, Montreal, Quebec H4A 3J1 Room E05.1811.2. Telephone 514-934-1934 extension 53333 email@example.comA 47-year-old man received chemotherapy for the treatment of refractory acute myeloid leukemia. Two weeks after re-induction, he developed fever, neutropenia, nausea and severe vomiting with abdominal pain. Computed tomography of the abdomen showed a small bowel obstruction with ischemic changes of the jejunum concerning for mesenteric ischemia (panel A). An urgent open laparotomy was performed revealing two areas of jejunal necrosis (panel B) and the patient underwent a partial small bowel resection with primary anastomosis.Histopathological examination of the jejunum with Grocott staining demonstrated ischemic necrosis associated with angioinvasive zygomycosis (panel C). Rhizopus oryzae was identified as the causative pathogen using polymerase chain reaction followed by DNA sequence analysis on the pathology specimen.The patient was treated intravenously with liposomal amphotericin and subsequently transitioned to oral isavuconazole. He was subsequently discharged from the hospital and died approximately 1 year later of progressive AML.Gastrointestinal mucormycosis remains a rare infection among immunocompromised hosts and a high index of suspicion is imperative (1). Its presentation can mimic ischemic colitis often resulting in a diagnosis made by pathology and not by conventional culture. Successful management includes early surgical resection and initiation of appropriate antifungal therapy.1. Spellberg B. Gastrointestinal mucormycosis: an evolving disease. Gastroenterol Hepatol (N Y). 2012;8(2):140-2.
An 89-year-old woman who had type 2 diabetes mellitus suddenly presented with abdominal pain. Abdominal computed tomography showed thickening of the wall and intramural gas in the gastric hilum, suggesting emphysematous gastritis. The patient underwent treatment with a proton pump inhibitor, and broad-spectrum antibacterial agents.