Semra Paydas

Granulocytic sarcoma: 32 cases and review of the literature.

Thirty-two cases of granulocytic sarcoma (GS) are reported in this paper. Age range was from 16 – 70 years. GS was accompanied by AML in 13 cases, ALL (My+) in one case, CML in 11 cases and MDS in two cases. GS was diagnosed simultaneously with leukemia in five cases and preceded the leukemia in eight. Lymph node and soft tissue were the most commonly detected localizations. Seven cases had first been diagnosed as NHL. Histopathologically blastic, immature and mature variants were found in 11, nine and 11 cases respectively and overall survival was shortest in the blastic type. Myeloperoxidase and lysozyme were found to be positive in 30 and 24 cases respectively. Therapy was radiation in five cases and surgery in three. Systemic chemotherapy was given to the cases. The clinical outcome of the patients after the diagnosis of GS was poor. GS is a unique entity; prognosis is poor but it is important to detect the signaling pathways associated with migration of myeloid cells to the extra-medullary tissues. The critical factors for detecting this interesting tumor are to be aware of this disease, cooperation between clinician and pathologist and the application of special stains to detect the myeloid origin.

Sweet's syndrome associated with G-CSF

Summary. Sweets syndrome (SS) developed in two patients with acute myeloid leukaemia (AML) treated with granulocyte colony stimulating factor (G‐CSF) for febrile neutropenia due to AML chemotherapy. Fever, painful skin and conjunctival lesions developed and neutrophilic infiltration was detected at biopsy specimens. Neutrophilia was not detected. Skin lesions regressed within 1–2 weeks and conjunctival lesions within 4 weeks following the cessation of G‐CSF. We conclude that SS may be a complication of G‐CSF therapy and tender skin and/or conjunctival lesions developing during G‐CSF therapy should suggest the possibility of SS.

Prognostic Significance of Microvessel Density and Vascular Endothelial Growth Factor (VEGF) Expression in non-Hodgkin's Lymphoma

Angiogenesis has a major role in the pathogenesis of malignancies. Studies involving the role of angiogenesis have been most commonly performed in solid tumors. However, studies related to hemapoietic neoplasia and angiogenesis are relatively limited. We investigated the role of angiogenesis in non-Hodgkins lymphomas (NHLs) and its relation with clinical and histopathologic prognostic indicators. In this respect, angiogenesis markers were evaluated in 71 patients with NHL and these were compared with other prognostic indicators including age, gender, histological grade, stage, extranodal involvement and survival. Microvessel density (MVD) using Factor VIII monoclonal antibody and vascular endothelial growth factor (VEGF) using monoclonal antibody for VEGF expression were studied in paraffin-embedded tissue samples. We did not find a significant relationship between MVD and patient characteristics including age, gender, stage, histological grade, nodal status, international prognostic index (IPI), and response to treatment. MVD was found to be greater in cases with B symptoms compared to those without B symptoms (14.6 ± 5.7 and 11.4 ± 5.3, respectively, p = 0.002). No significant relationship was found between VEGF and age, gender, stage, histological grade, IPI, and overall survival. The complete and partial response rate to therapy was significantly higher in VEGF-negative patients than in the VEGF-positive patients (p = 0.003). In conclusion, there appears to be a role for angiogenesis and angiogenic factors in NHLs. The combination of anti-angiogenic drugs with conventional anti-neoplastic treatment will probably be used in the future. Larger series of patients are needed to determine the prognostic value of angiogenesis in NHL.

Efficacy of pneumatic compression and low-level laser therapy in the treatment of postmastectomy lymphoedema: a randomized controlled trial:

Objective: To compare the long-term efficacy of pneumatic compression and low-level laser therapies in the management of postmastectomy lymphoedema. Design: Randomized controlled trial. Setting: Department of Physical Medicine and Rehabilitation of Cukurova University, Turkey. Subjects: Forty-seven patients with postmastectomy lymphoedema were enrolled in the study. Interventions: Patients were randomly allocated to pneumatic compression (group I, n=24) and low-level laser (group II, n=23) groups. Group I received 2 hours of compression therapy and group II received 20 minutes of laser therapy for four weeks. All patients were advised to perform daily limb exercises. Main measures: Demographic features, difference between sum of the circumferences of affected and unaffected limbs (▵C), pain with visual analogue scale and grip strength were recorded. Results: Mean age of the patients was 48.3 (10.4) years. ▵C decreased significantly at one, three and six months within both groups, and the decrease was still significant at month 12 only in group II (P = 0.004). Improvement of group II was greater than that of group I post treatment (P = 0.04) and at month 12 after 12 months (P = 0.02). Pain was significantly reduced in group I only at posttreatment evaluation, whereas in group II it was significant post treatment and at follow-up visits. No significant difference was detected in pain scores between the two groups. Grip strength was improved in both groups, but the differences between groups were not significant. Conclusions: Patients in both groups improved after the interventions. Group II had better long-term results than group I. Low-level laser might be a useful modality in the treatment of postmastectomy lymphoedema.

Role of granulocyte colony-stimulating factor in the treatment of mucormycosis

Several problems in the management of life-threatening mucormycosis remain unresolved, necessitating new methods of management. Four patients with histopathologically proven rhinocerebral mucormycosis were treated with high cumulative doses of granulocyte colony-stimulating factor (G-CSF). All had multiple predisposing factors for mucormycosis, particularly leukemia and neutropenia. Two patients refractory to fluconazole therapy were treated with liposomal amphotericin B. The improvement in clinical manifestations was closely related to neutrophil recovery, and all patients were alive at the end of therapy. In addition to surgical debridement and antifungal therapy, G-CSF seems to have played a role in their survival.

Prognostic significance of EBV-LMP1 and VEGF-A expressions in non-Hodgkin's lymphomas ,

BACKGROUND AND AIM EBV is an important virus in the pathogenesis of NHL. VEGF-A is the essential factor in tumor angiogenesis. There is evidence of cross talk between angiogenesis and viral carcinogenesis. The viral latent protein LMP1, may play a role by inducing expression of angiogenic factors In this study EBV-LMP1 and VEGF-A expressions have been studied in cases with NHL and prognostic significance of these has been evaluated. PATIENTS AND METHODS One hundred seventy-seven cases (60 had low grade lymphoma (LGL), 117 had aggressive lymphoma (AL)) with NHL have been included in this analysis. Immunohistochemistry has been used for the detection of EBV and VEGF-A. RESULTS EBV was found in 25 cases (14%); 5 of 60 cases with LGL while 20 of 117 cases with AL had EBV positivity; (OR: 2.3, 95% CI: 0.8-6.3, p=0.113). VEGF-A expression was found in 108 cases (61%); 30 of 60 cases with LGL and 78 of 117 cases with AL showed VEGF-A expression. There was an association between VEGF-A and aggressive histology (OR: 2.0, 95% CI: 1.1-3.8, p=0.031). EBV positivity was associated with VEGF-A expression in diffuse large B cell lymphoma (DLBCL) (0.045). Mean Survival rates were shorter in EBV (+) and/or VEGF-A (+) cases. COMMENT Highly significant association between VEGF-A and EBV expression and survival rate, suggests an association between angiogenesis and viral lymphomagenesis. Targeting both the angiogenesis and EBV may be important in the therapy of cases with NHL expressing EBV and/or VEGF-A.

Sweet's syndrome accompanying leukaemia: seven cases and review of the literature

Seven patients with Sweets Syndrome (SS) accompanying leukaemia are presented. Six had acute myeloid leukaemia and one chronic myeloid leukaemia. SS developed during G-CSF therapy in two patients and following long periods of chemotherapy-associated neutropenia in two. This finding may suggest a possible role of G-CSF in the pathogenesis of SS. SS was diagnosed during the first presentation of three patients with leukaemia. Skin lesions on the lower extremities in two patients, widespread distribution in one, a local infiltration at the inguinal region and pleural effusion in one were interesting findings in our patients which are not usual for classical SS.

Antioxidant enzyme levels in cases with gastrointesinal cancer

UNLABELLED The aim is to evaluate the antioxidant enzyme levels in tumoral tissues and accompanying normal tissues in gastrointestinal cancer; and compare the colorectal cancer (CRC) with gastric cancer (GC). METHOD Antioxidant enzymes including glutathione reductase (GR), glutathione peroxidase (GPX), superoxide dismutase (SOD), malondialdehyde (MDA) and glucose 6 phosphate dehyrogenase (G6PD) which are important for anti-oxidant functions were evaluated in fresh tumor tissues and adjacent normal tissues obtained from a total of 58 patients. RESULTS All the enzyme levels were higher in tumoral tissues compared to normal tissue from non-cancerous disease. There was not a significant difference for enzyme levels between CRC and GC groups except GPx. GPx activity tended to be higher in cases without serosal involvement (SI), and this activity was higher in cases without lymph node (LN) involvement in normal tissue (p=0.012). MDA activity was higher in cases without serosal involvement compared to with SI groups in tumor tissue (p=0.050). G6PD activity in normal tissue was higher in cases with serosal involvement and LN involvement (p=0.064, 0.046, respectively). GR activity was higher in signet ring cell cancer (SRC) than adeno cancer. In GC, G6PD activity in tumor was tended to be higher in undifferentiated cancer (p=0.071). CONCLUSION The antioxidant enzymes activities such as GPX, SOD, G6PD, MDA and GR were found to be related with malignant phenotype in gastrointestinal cancers. We need further studies to understand the biologic and clinical importance of these enzymes in GI cancers.

Pronostic significance of angiogenic/lymphangiogenic, anti-apoptotic, inflammatory and viral factors in 88 cases with diffuse large B cell lymphoma and review of the literature

BACKGROUND Diffuse large B cell lymphoma (DLBCL) is the most common subtype of Non-Hodgkins lymphomas (NHL). The outcome of these patients shows a wide variation. We evaluated the effect of six biologic parameters including Cyclooxygenase-2 (Cox-2), Survivin, Epstein Barr Virus (EBV), Vascular Endothelial Growth Factor-A (VEGF-A), Vascular Endothelial Growth Factor-C (VEGF-C), Thrombospondin-1 (TSP-1) and clinical parameters. PATIENTS AND METHODS A follow up study was conducted and 88 cases with DLBCL were included in the study. The data of 72 patients were eligible for the survival analyses. Immunohistochemistry was used to detect these parameters. RESULTS The ratio of positive cases for Cox-2, VEGF-A, Survivin, VEGF-C, EBV, TSP-1 were 71.6%, 64.8%, 60.2%, 36.4%, 21.6%, 14.8%, respectively. Survivin (+) cases showed higher LDH levels and VEGF-A (+) cases showed higher beta 2 microglobulin (B2M) levels compared with (-) cases. Mean survival rates were found to be significantly shorter in cases expressing VEGF-A, VEGF-C, EBV and Survivin than cases not expressing these. EBV expression (HR: 3.78; 95%CI: 1.47-9.74; p=0.006), VEGF-C expression (HR: 3.22; 95%CI: 1.07-9.68; p=0.037) and extranodal involvement (HR: 3.02; 95%CI: 1.01-8.97; p=0.047) were found to be independent risk factors for prognosis according to the Cox regression analysis. COMMENT Lymphangiogenesis (VEGF-C) and EBV related viral lymphomagenesis have been found to be related with prognosis in DLBCL patients.

IDA-FLAG regimen for the therapy of primary refractory and relapse acute leukemia: a single-center experience.

We evaluated efficacy and toxicity profiles of fludarabine, Ara-C, idarubicin, and G-CSF (Ida-FLAG) combination chemotherapy in 56 refractory and/or relapsed acute leukemia patients. Patients were treated with fludarabine phosphate 25 mg/m2/d (d1-5), Ara-C 2 g/m2/d (d1-5), idarubicin 12 mg/m2/d (d1-3), G-CSF was given subcutaneously from sixth day until absolute neutrophil count (ANC) >500/μL. One third of the acute myeloblastic leukemia (AML) and 45% of acute lymphoblastic leukemia (ALL) cases were primary refractory disease. In AML patients, complete remission (CR) was achieved in 15 cases (53.6%). One case showed partial remission (PR) (3.6%) and 12 cases (42.8%) had resistant to this regimen (RD). Grade IV hematologic toxicity occurred in all AML cases. Leukocyte recovery time was 16 days. Nonhematologic complications were mild to moderate nausea, vomiting, and mucositis and could be controlled by routine measures. Stem cell transplantation was performed in 5 patients and all achieved CR, 2 autologous and 3 allogeneic. In ALL patients, CR and PR were obtained in 8 (42.2%) and 2 (10.5%) of 22 cases; disease was resistant to Ida-FLAG in 9 (47.3%) cases. Grade IV hematologic toxicity occurred in all ALL cases. Leukocyte recovery time was 17 days. Nonhematologic toxicity consisted of nausea, vomiting, and mucositis and could be controlled by supportive therapy. Autologous transplantation was performed in 1 patient, but relapse disease occurred after 5 weeks. There was no correlation between response rate and leukemia subtype (AML versus ALL), leukocyte count, age, sex, disease status (de novo versus secondary), and RFS (early versus late relapse) (P > 0.05). Median survival was 16 weeks in all cases (22 weeks in AML versus 13 weeks). At present, only 3 patients are alive and 2 of these are in continuous remission. The rest of the patients died. In conclusion, Ida-FLAG is a good choice in cases with refractory/relapsing acute leukemia for salvage chemotherapy. High efficacy and a low-toxicity profile are preferable properties of this regimen, and this regimen has been found to be useful for cytoreduction, especially in candidates for allo-SCT.