Humayun Islam

A rare case of the upper extremity diffuse large B-cell lymphoma mimicking soft tissue sarcoma in an elderly patient

Diffuse large B-cell lymphoma (DLBCL) is the most common type of non-Hodgkin lymphoma, with about 30% of new cases presenting with extranodal disease. Lesions originating from soft tissues of the upper extremities are extremely rare and may mimic other malignancies like sarcoma. We present a case of an elderly patient with right upper extremity (RUE) mass which was proven to be DLBCL instead of sarcoma. We emphasize the increasing need for investigating new therapeutic options for patients of extreme age and/or with underlying heart disease.

Hemophagocytic lymphohistiocytosis: macrophages engulfing red cells and neutrophils.

A 47-year-old female presented with a 3-day history of high grade fever, myalgia, abdominal discomfort, vomiting, shortness of breath, headache, and altered mental status. She was hypotensive with acute respiratory distress syndrome and multi-organ failure. Laboratory workup was significant for pancytopenia, elevated liver enzymes, acute kidney injury, elevated creatine kinase levels and ferritin level of 10,000 mcg/L.

Genomic Analysis Reveals Distinct Subtypes in Two Rare Cases of Primary Ovarian Lymphoma

Primary (localized) non-Hodgkin lymphoma (NHL) of the ovary is extremely rare; only a few cases have been reported in the literature. We report two cases of primary ovarian lymphoma (POL), one involving bilateral ovaries in a 15-year-old girl and other involving one ovary in a 5-year-old girl. This report describes detailed clinical, histopathological, and imaging findings, along with the review of literature of primary diffuse large B-cell lymphoma (DLBCL) arising from an ovary. In addition, we describe findings of targeted capture panel sequencing on both tumors and identify the major genetic mutations that are recurrently mutated in pan-cancers. Compared to the genomic mutation features of major subtypes of DLBCL, we distinguish that each POL belongs to distinctive subtypes, GCB (germinal center B-cell subtype) DLBCL and ABC (activated B-cell subtype) DLBCL, respectively. The findings from the genomic analysis may help to understand the pathogenesis of POL and to guide potential targeted therapy in the future.

Acute promyelocytic leukemia co-existing with JAK2 V617F positive myeloproliferative neoplasm: a case report.

The V617F mutation of Janus-associated kinase 2 (JAK2) is commonly seen in myeloproliferative neoplasms (MPN). Transformation of JAK2 positive MPNs to acute leukemia has been reported. We here report a case of acute promyelocytic leukemia which was later confirmed to have a co-existing JAK2 V617F positive MPN. In addition, the patient was found to have FLT3-TKD mutation, which, together with PML/RARa, could play a role in the MPN transformation to APL.

Response but severe toxicity with low dose decitabine in a Werner’s syndrome patient with acute myeloid leukemia and t(9;19)(p13;p13)

Werner’s syndrome is a rare autosomal recessive premature aging syndrome caused by mutations in the Werner RecQ helicase. Patients typically die in their 5th decade from cardiovascular disease or cancer. There are few reports of the treatment of malignancies in these patients. We previously reported a patient with Werner’s syndrome who expired from multi-organ failure after treatment of AML with intensive chemotherapy. We currently report a patient with Werner’s syndrome and AML who was treated with decitabine, a low intensity regimen commonly used to treat elderly patients. This patient also developed severe toxicity, but recovered and obtained a complete remission. Unfortunately the patient’s disease progressed 5 months later and he then expired Correspondence to: Karen Seiter, M.D, Department of Medicine, Room 205 Munger Pavilion, New York Medical College, Valhalla, New York 10595, USA, Tel: (914) 493-7514, Fax: (914) 594-4420, E-mail: karen_seiter@nymc.edu

Extramedullary hematopoiesis presented as cytopenia and massive paraspinal masses leading to cord compression in a patient with hereditary persistence of fetal hemoglobin

BackgroundExtramedullary hematopoeisis (EMH) can occur in various physiological and pathologic states. The spleen is the most common site of EMH.Case presentationWe report a case with hereditary persistence of fetal hemoglobin with extramedullary hematopoiesis presented as cord compression and cytopenia secondary to multi-paraspinal masses.ConclusionTreatment can be a challenge. Relapse is a possibility.

Franklin's disease: immunoglobulin heavy chain disease

A 64-year-old male presented with persistent fatigue, weakness and abdominal discomfort. He was found to have pancytopenia and hepatosplenomegaly. His bone marrow examination was mildly hypocellular with trilineage hematopoiesis. Serum protein electrophoresis revealed broad beta protein area but no gamma monoclonal spike (A). Surprisingly, immunofixation study identified monoclonal γ-heavy chain with no corresponding κ- or λ-light chains (B).

Multiple myeloma with leptomeningeal involvement and positive CSF

A 50-year-old female with multiple myeloma was initially treated with lenalidomide/bortezomib/dexamethasone. She had progression of disease after three cycles. She was then treated with DB-PACE (dexamethasone, bortezomib, cisplatin, doxorubicin, cyclophosphamide, etoposide) ×3 cycles.