CASE 1. ARR 16 year old Ugandan male Senior 2 student No history of alcohol, no Tobacco

Transcription

1 CASE 1 ARR 16 year old Ugandan male Senior 2 student No history of alcohol, no Tobacco

2 HISTORY Index presentation to UCI, 06/09/2018 Referral Diagnosis: Burkitt s Lymphoma

3 HISTORY 6 months of abdominal pain which is dull in nature, associated with distension and early satiety Associated constitutional symptoms Patient had a laparotomy done, wedge biopsy done which revealed Burkitt's lymphoma and hence referral to UCI ROS unremarkable

4 PHYSICAL EXAM qgeneral Exam: young man, severely cachectic, no peripheral lymphadenopathy qabdominal Exam: huge intraabdominal mass, extending up to the epigastrium, non tender No palpable hepatomegaly, splenomegaly

5 HISTOLOGY: HE Histologically, showed tissue composed of a diffuse infiltration of monomorphic medium sized cells with abundant basophilic cytoplasm, non-cleaved round nuclei with coarse chromatin and with a starry sky pattern with very many abnormal mitotic figures Immunohistochemistry: The Ki 67 index is about 98% Diagnosis/conclusion: features are of Burkitt s Lymphoma

6 HISTOLOGY

7 INVESTIGATIONS qabdominal Scan: There is a complex heterogenous solid mass within the abdominal cavity ( )cm. it occupies the entire pelvic region and also exerting mass effect on the liver and right kidney displacing them upwards. Mild hepatosplenomegaly qcardiac Echo: Normal biventricular systolic function EF = 62% qbone marrow examination: medium sized atypical lymphoid cells constituting 20 % of all nucleated cells Morphological features in keeping with marrow involvement with NHL-Burkitt like

8 INVESTIGATIONS qhiv serology: Negative CBC (01/10/2018) WBC ANC Hb MCV PLT LFTs and RFTs essentially normal qldh results: 369.4

9 INVESTIGATIONS: CSF Macroscopy: clear and colorless CSF Microscopy: under pap stain cytology shows pauci cellular smear with no atypical cells or Burkitt s lymphoma cells noted on the examined smear Cytomorphologically, there are no lymphoid cells/burkitt s lymphoma cells seen on the examined slide

10 ASSESSMENT 16 year old with Burkitt s lymphoma high risk disease Plan: Allopurinol, fluids

11 DISCUSSION Comments/ questions Treatment options?

12 CASE 2 AD 24 year old Ugandan male Nurse No history of alcohol, no Tobacco

13 HISTORY Index presentation to UCI, 10/07/2017 Referral Diagnosis: Acute myeloid leukemia (70% myeloblasts), following a bone marrow diagnosis (June 2018)

14 CHRONOLOGY September 2017, Patient was enrolled into care in UCI Patient had received with standard doses 3+7, did not achieve remission Her treatment was complicated with severe sepsis including a perineal abscess Received a second induction 5+2 Repeat bone marrow revealed residual disease of 5-10%myeloblasts January 2018, patient was admitted to UCI for HDAC 1

15 CHRONOLOGY February 2017, received high HDAC 2 Developed severe marrow suppression: support April 2017, received HDAC 3 May 2018, admitted for HDAC 4 June 2018, bone marrow exam revealed myeloblast count less than 5%, IHC CD 34, NO FOCI OF MYELOBLASTS Patient was in remission Patient was surveillance: monthly CBC

16 CHRONOLOGY September 2018, repeat bone marrow was done Bone marrow aspirate: Granulated myeloblasts constituting 70% of all the nucleated cells some having Auer rods Immunohistochemistry: CD 34 highlighted myeloblasts at about 70% Patient is on supportive care Antibiotics Blood products Antipyretics

17 INVESTIGATIONS qabdominal Scan: Normal qcxr: Normal qcardiac echo: Normal cardiac structure and function

18 INVESTIGATIONS qhiv serology: Negative Date WBC ANC Hb Plt 08/05/ /05/ /09/ /09/ /09/ /10/ qldh results: Essentially normal

19 Impression qacute Myeloid Leukemia with Early Relapse

20 DISCUSSION Treatment options??flag Other combinations Allogenic BMT