Arash Azin
University of Toronto
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International Journal of Surgery Case Reports | 2014
Arash Azin; Jennifer M. Racz; M. Carolina Jimenez; Supreet Sunil; Anna Porwit; Timothy Jackson; Allan Okrainec; Fayez A. Quereshy
INTRODUCTION AML is the most common form of leukemia in adults. In rare circumstances AML may present in the form of extra-medullary disease. Gallbladder infiltration with myeloblasts is rare and only a few cases exist in the literature describing this entity. PRESENTATION OF CASE We present a rare case of AML relapse in the form of extramedullary infiltration of the gallbladder in a 50-year-old male patient. The leukemic infiltration presented as symptomatic cholecystitis and sepsis. A laparoscopic cholecystectomy was performed and the gallbladder was pathologically examined. Histopathologic examination demonstrated multiple scattered, highly atypical single cells admixed with some plasma cells, small lymphocytes and macrophages consistent with leukemic infiltration. The abnormal cells demonstrated immunohistochemical staining for CD68, CD33 and CD117. The patient did well post-operatively but the relapse precluded him from bone marrow transplantation. DISCUSSION Although AML is relatively common, 3 cases per 100,000 population, extramedullary disease in the form of gallbladder infiltration is exceedingly rare. An extensive review of the literature revealed only four cases of myeloid infiltration of the gallbladder. To our knowledge this is the only case of relapsing disease in the form of gallbladder infiltration presenting as symptomatic cholecystitis in a pre-bone marrow transplantation patient. CONCLUSION This case highlights the importance of maintaining a high index of suspicion of atypical manifestations of AML when managing refractory sepsis. Extramedullary manifestations of AML in the form of gallbladder infiltration must be considered in the differential diagnosis of patients with a history of myeloid malignancies and for patients whom fail conventional non-operative management.
Surgical Endoscopy and Other Interventional Techniques | 2018
Arash Azin; Trevor Wood; Dhruvin Hirpara; Emily Le Souder; Sami A. Chadi; Timothy Jackson; Allan Okrainec; Fayez A. Quereshy
BackgroundColonoscopy has a reported localization error rate as high as 21% in detecting colorectal neoplasms. Preoperative repeat endoscopy has been shown to be protective against localization errors. There is a paucity of literature assessing the utility of staging computerized tomography (CT) and repeat endoscopy as diagnostic tools for detecting localization errors following initial endoscopy. The objective of this study is to determine the diagnostic characteristics of staging CT and repeat endoscopy in correcting localization errors at initial endoscopy.MethodsA retrospective cohort study was conducted at a large tertiary academic center between January 2006 and August 2014. All patients undergoing surgical resection for CRC were identified. Group comparisons were conducted between (1) patients that underwent only staging CT (staging CT group), and (2) patients that underwent staging CT and repeat endoscopy (repeat endoscopy group). The primary outcome was localization error correction rate for errors at initial endoscopy.Results594 patients were identified, 196 (33.0%) in the repeat endoscopy group, and 398 (77.0%) patients in the staging CT group. Error rates for each modality were as follows: initial endoscopy 8.8% (95% CI 6.5–11.0), staging CT 9.3% (95% CI 6.5–11.0), and repeat endoscopy 2.6% (95% CI 0.3–4.7); p < 0.01. Repeat endoscopy was superior to staging CT in correcting localization errors for left-sided / rectal lesions (81.2% vs. 33.3%; p < 0.01), right-sided lesions (80.0% vs. 54.5%; p = 0.21), and overall lesions (80.8% vs. 42.3%; p < 0.01). Repeat endoscopy compared to staging CT demonstrated relative risk reduction of 66.7% (95% CI 22–86%), absolute risk reduction of 38.5% (95% CI 14.2–62.8%), and odds ratio of 0.18 (95% CI 0.05–0.61) for correcting errors at initial endoscopy.ConclusionsRepeat endoscopy in colorectal cancer is superior to staging CT as a diagnostic tool for correcting localization-based errors at initial endoscopy.
Journal of Surgical Oncology | 2018
Emily Le Souder; Arash Azin; Dhruvin Hirpara; Richard Walker; Sean P. Cleary; Fayez A. Quereshy
Simultaneous resection for colorectal cancer with synchronous liver metastases is an established alternative to a staged approach. This study aimed to compare these approaches with regards to economic parameters and short‐term outcomes.
Journal of Surgical Oncology | 2018
Emily Le Souder; Arash Azin; Trevor Wood; Dhruvin Hirpara; Ahmad Elnahas; Sean P. Cleary; A. Wei; Richard Walker; Armen Parsyan; Sami A. Chadi; Fayez A. Quereshy
Patients with colorectal cancer with synchronous liver metastases may undergo a staged or a simultaneous resection. This study aimed to determine whether the time to adjuvant chemotherapy was delayed in patients undergoing a simultaneous resection.
Breast Cancer Research and Treatment | 2018
Maryam Elmi; Arash Azin; Ahmad Elnahas; David R. McCready; Tulin Cil
BackgroundPatients with genetic susceptibility to breast and ovarian cancer are eligible for risk-reduction surgery. Surgical morbidity of risk-reduction mastectomy (RRM) with concurrent bilateral salpingo-oophorectomy (BSO) is unknown. Outcomes in these patients were compared to patients undergoing RRM without BSO using a large multi-institutional database.MethodsA retrospective cohort analysis was conducted using the American College of Surgeon’s National Surgical Quality Improvement Program (NSQIP) 2007–2016 datasets, comparing postoperative morbidity between patients undergoing RRM with patients undergoing RRM with concurrent BSO. Patients with genetic susceptibility to breast/ovarian cancer undergoing risk-reduction surgery were identified. The primary outcome was 30-day postoperative major morbidity. Secondary outcomes included surgical site infections, reoperations, readmissions, length of stay, and venous thromboembolic events. A multivariate analysis was performed to determine predictors of postoperative morbidity and the adjusted effect of concurrent BSO on morbidity.ResultsOf the 5470 patients undergoing RRM, 149 (2.7%) underwent concurrent BSO. The overall rate of major morbidity and postoperative infections was 4.5% and 4.6%, respectively. There was no significant difference in the rate of postoperative major morbidity (4.5% vs 4.7%, p = 0.91) or any of the secondary outcomes between patients undergoing RRM without BSO vs. those undergoing RRM with concurrent BSO. Multivariable analysis showed Body Mass Index (OR 1.05; p < 0.001) and smoking (OR 1.78; p = 0.003) to be the only predictors associated with major morbidity. Neither immediate breast reconstruction (OR 1.02; p = 0.93) nor concurrent BSO (OR 0.94; p = 0.89) were associated with increased postoperative major morbidity.ConclusionThis study demonstrated that RRM with concurrent BSO was not associated with significant additional morbidity when compared to RRM without BSO. Therefore, this joint approach may be considered for select patients at risk for both breast and ovarian cancer.
Clinical Case Reports | 2017
Supreet Sunil; Juliana Restrepo; Arash Azin; Dhruvin Hirpara; Sean Cleary; Michelle C. Cleghorn; Alice Wei; Fayez A. Quereshy
Surgical resection is the only potential cure for colorectal cancer with synchronous liver metastases (SLM). Simultaneous resection of colorectal cancer and SLM using robotic‐assistance has been rarely reported. We demonstrate that robotic‐assisted simultaneous resection of colorectal cancer and SLMs is feasible, safe, and has potential to demonstrate good oncologic outcomes.
Surgical Endoscopy and Other Interventional Techniques | 2016
Andrew Yuen; Ahmad Elnahas; Arash Azin; Allan Okrainec; Timothy Jackson; Fayez A. Quereshy
Surgical Endoscopy and Other Interventional Techniques | 2017
Arash Azin; Fady Saleh; Michelle C. Cleghorn; Andrew Yuen; Timothy Jackson; Allan Okrainec; Fayez A. Quereshy
Journal of Surgical Research | 2017
Arash Azin; Emily Le Souder; David R. Urbach; Allan Okrainec; Sami A. Chadi; Fayez A. Quereshy; Timothy Jackson; Ahmad Elnahas
Journal of Surgical Research | 2018
Trevor Wood; Arash Azin; Fayez A. Quereshy