DOCSLIB.ORG

Case Report Refractory Chronic GVHD Emerging After Splenectomy in a Marrow Transplant Recipient with Accelerated Phase CML

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Case Report Refractory Chronic GVHD Emerging After Splenectomy in a Marrow Transplant Recipient with Accelerated Phase CML Bone Marrow Transplantation (2003) 32, 333–335 & 2003 Nature Publishing Group All rights reserved 0268-3369/03 $25.00 www.nature.com/bmt Case report Refractory chronic GVHD emerging after splenectomy in a marrow transplant recipient with accelerated phase CML CA Rodrigues, FA Fermino, Y Vasconcelos and JSR de Oliveira Hospital Sa˜o Paulo, Sa˜o Paulo, Brazil Summary: between splenectomy and worsening of GVHD.5–8 We report a case in which this association clearly occurred. We report a 39-year-old female patient who underwent HLA-identical sibling allogeneic BMT for CML in accelerated phase. Severe pancytopenia refractory to G- Case report CSF associated with progressive splenomegaly and RBC/ platelet transfusion dependency were present from day 39-year-old female patient presented with fatigue and +60 after BMT. MRD assessed by FISH and RT-PCR abdominal fullness.Massive splenomegaly was found and multiplex for BCR-ABL rearrangement was negative, and WBC showed marked leukocytosis (160 Â 109/l) with left- complete chimerism was documented by VNTR on days shifted myeloid series and basophilia.Bone marrow +100, +180, +360 and 2 years after BMT. Splenect- aspiration and Ph1 chromosome positivity confirmed the omy was performed on day +225 and pancytopenia diagnosis of CML.She was admitted for HLA identical resolved but chronic extensive graft-versus-host disease sibling donor BMT, and the conditioning regimen consisted developed, with hepatic cholestasis, diffuse scleroderma of busulphan (16 mg/kg)/cyclophosphamide (120 mg/kg).9 and sicca-like syndrome. She was sequentially and GVHD prophylaxis consisted of short-term methotrexate progressively treated with different immunosuppressive plus cyclosporine (CyS).10 Engraftment occurred on day therapy combinations with no clear benefit. On day +940, +28.On day +60, a routine CBC showed pancytopenia she presented with infection over the previously present (WBC 2.2 Â 109/l with ANC 0.602 Â 109/l, hemoglobin ulcers on both limbs, which culminated in septic shock of 7.2 g/dl and platelet count of 23 Â 109/l) associated with and death on day +1041. We conclude that, although progressive splenomegaly.Bone marrow aspiration and splenectomy may reverse poor graft function after biopsy revealed a normocellular marrow.Over the next allogeneic BMT, hyposplenism may trigger or worsen 5 months, she had eight febrile neutropenic episodes chronic extensive GVHD leading to increased morbidity requiring hospital admission and treatment with broad- and mortality. spectrum antibiotics.Daily subcutaneous 5 mg/kg G-CSF Bone Marrow Transplantation (2003) 32, 333–335. infusions were given for 14 days with no improvement.She doi:10.1038/sj.bmt.1704122 received a total of 19 U of RBC and 75 random units Keywords: BMT; chronic GVHD; splenectomy of platelets.G-Band karyotyping was normal.MRD searched by FISH and RT-PCR multiplex for BCR-ABL rearrangements were negative and complete chimerism was documented by VNTR on days +100, +180, +360 and 2 Allogeneic BMT is a therapeutic option for many years after BMT.We concluded that the patient was hematologic malignancies and the only curative available entirely donor on chimerism studies and had evidence of treatment for CML to date.Graft-versus-host disease hypersplenism. (GVHD) remains one of the major complications and has As she remained pancytopenic and transfusion depen- a high mortality rate.Splenectomy has been undertaken to dent for more than 7 months after BMT, splenectomy was reverse poor graft function because of hypersplenism after performed on day +225.The spleen had no morphological allogeneic BMT, with satisfactory results.1–3 Previous or cytogenetic evidence of tumor.Pancytopenia and studies indicate that surgical or functional postallogeneic dependency on transfusion resolved after splenectomy. BMT hyposplenism may be associated with a higher Edema and rash in both forearms and hands were seen incidence of chronic extensive GVHD.4 However there on day +260 and evolved into a diffuse scleroderma are conflicting data in the literature about the relationship (Figure 1).As part of the extensive c-GVHD, a sicca-like syndrome and liver cholestasis were diagnosed at that time. She was sequentially treated with CyS plus prednisone and weekly high-dose immunoglobulin infusions.CyS was Correspondence: Dr JSR Oliveira, Division of Hematology, Universi- dade Federal de Sa˜ o Paulo, R.Botucatu, 740 30 andar Sa ˜ o Paulo, discontinued on day +921 because of acute renal failure. SP 04023 900, Brazil On day +486, she developed Herpes Zoster lesions on the Received 1 November 2002; accepted 3 February 2003 trunk that progressed to local ulceration with secondary Chronic extensive GVHD after splenectomy in BMT for CML CA Rodrigues et al 334 complications were required.On day +1034, she had a Staphylococcus aureus systemic infection with worsening of the limb ulceration, culminating in septic shock and death on day +1041. Discussion We describe a patient who underwent allogeneic BMT for CML in accelerated phase and developed a severe and persistent pancytopenia in the post transplant period associated with splenomegaly and hypersplenism.Splenect- omy was performed and the pancytopenia resolved, but a progressive de novo chronic extensive GVHD emerged after the surgery.All immunosuppressive measures adopted failed to change the course of the chronic GVHD which had a fatal outcome. Post transplant hypersplenism was first described in 1992 and should be considered in patients presenting with pancytopenia and splenomegaly after allogeneic BMT.It has been associated with splenic hypervascularity, and expanded vascular capacity and proliferation of infused stem cells in the spleen, possibly related to physical impediment of flow.3 Splenectomy has been shown to Figure 1 Sclero-like lesions. resolve pancytopenia in 11 previously reported cases, with no associated comorbidity.1–3 Accordingly, in the present case, splenectomy successfully resolved the pancytopenia. There is controversy in the literature regarding the relationship between splenectomy and chronic GVHD. Ringde´ n et al5 have shown an increased incidence of acute GVHD and higher death rate in patients splenectomized before BMT.The same European group confirmed later that splenectomy was an important risk factor for acute and chronic GVHD on bivariate analysis and in only chronic GVHD on multivariate analysis.6 Michallet et al7 evaluated 157 patients who underwent BMT from an HLA- identical sibling and found that splenectomy was the most important factor determining GVHD severity on multi- variate analysis.However, a more recent retrospective analysis to evaluate the role of splenectomy on BMT outcome showed no significant influence of splenectomy on acute or chronic GVHD, although it was associated with an increased risk for all grades of acute GVHD, but this was not statistically significant.8 The exact mechanism of the influence of splenectomy on GVHD incidence and severity is not known.The most likely hypothesis is that the spleen functions as a ‘filter’ for activated T cells by the activity of HLA-DR and CD1a- positive cells (dendritic cells).11 Donor-derived alloreactive T cells, post-thymic activated CD4+ T cells and T cells Figure 2 Limb ulcerations. immunoreactive to minor HLA antigens, which are extremely important in the pathogenesis of chronic GVHD, could then possibly be ‘cleared’ by the spleen.By this mechanism, the spleen may also play a role in modulating infection and concomitant ulceration of both limbs the activation of different helper T-cell subsets (Th1 vs Th2) (Figure 2).She underwent hyperbaric oxygen therapy with minimizing the effects of cytokines secreted by Th2 cells some recovery.The generalized scleroderma evolved to (IL-4, IL-5, IL-10), which predominate in chronic affect the trunk and limbs.A year post transplant, PUVA GVHD.12 The other two hypotheses include the role of therapy associated with daily MMF (2 g), thalidomide the spleen in the modulation of infections,13 and its (600 mg) and prednisone (80 mg) were sequentially and production of an immunosuppressive peptide in animal progressively initiated.Several admissions for infectious studies, never found in human studies.14 Infection was Bone Marrow Transplantation Chronic extensive GVHD after splenectomy in BMT for CML CA Rodrigues et al 335 constantly present in this case: before splenectomy because of cytomegalovirus serology in recipients and donors – acute of severe neutropenia and after splenectomy because of graft-versus-host disease, and splenectomy. Transplantation severe chronic GVHD, despite a normal neutrophil count. 1990; 49: 1100–1105. We believe that infection was also an important risk factor 7 Michallet M, Corront B, Bosson JL et al.Role of splenectomy in the development of chronic GVHD in this case. in incidence and severity of acute graft-versus-host disease: a Bone Marrow Transplant It is also important to emphasize that the patient multicenter study of 157 patients. 1991; 8: 13–17. remained in continuous complete remission during the 8 Kalhs P, Schwarzinger I, Anderson G et al.A retrospective whole post transplant period and that a chronic GVHD- analysis of the long-term effect of splenectomy on late associated GVL effect may have had an important role. infections, graft-versus-host disease, relapse, and survival after We conclude that, although splenectomy may reverse allogeneic marrow transplantation for CML. Blood 1995; 86: poor graft function after allogeneic BMT, surgical hypo- 2028–2032. splenia may trigger or worsen chronic extensive GVHD 9 Santos GW, Tutschka PJ, Brookmeyer R et al.Marrow leading to an increase in morbidity and mortality. transplantation for acute nonlymphocytic leukemia after treatment with busulfan and cyclophosphamide. N Eng J Med 1983; 309: 1347–1353. References 10 Storb R, Deeg HJ, Whitehead J et al.Marrow transplantation for leukemia and aplastic anemia: two controlled trials of a 1 Richard C, Romon I, Perez-Encinas M et al.Splenectomy for combination of methotrexate and cyclosporine vs cyclosporine poor graft function after allogeneic BMT in patients with alone for prophylaxis of acute graft-vs-host disease.
Load more

Recommended publications
  • Atrial Fibrillation and Splenic Infarction Presenting with Unexplained Fever and Persistent Abdominal Pain - a Case Report and Review of the Literature
    Case ReportSplenic Infarction Presenting with Unexplained Fever and Persistent Acta Abdominal Cardiol SinPain 2012;28:157-160 Atrial Fibrillation and Splenic Infarction Presenting with Unexplained Fever and Persistent Abdominal Pain - A Case Report and Review of the Literature Cheng-Chun Wei1 and Chiung-Zuan Chiu1,2 Atrial fibrillation is a common clinical problem and may be complicated with events of thromboembolism, especially in patients with valvular heart disease. Splenic infarction is a rare manifestation of the reported cases. The symptoms may vary from asymptomatic to severe peritonitis, though early diagnosis may lessen the probability of severe complications and lead to a good prognosis. We report a 79-year-old man with multiple cardioembolic risk factors who presented with fever and left upper quadrant abdominal pain. To diagnose splenic infarction is challenging for clinicians and requires substantial effort. Early resumption of the anti-coagulation component avoids complications and operation. Key Words: Atrial fibrillation · Splenic infarction · Thromboembolism event · Valvular heart disease INTRODUCTION the patient suffered from severe acute abdominal pain due to splenic infarction. Fortunately, early diagnosis Splenic infarction is a rare cause of an acute abdo- and anticoagulation therapy helped the patient to avoid men. According to a sizeable autopsy series, only 10% emergency surgery and a possible negative outcome. of splenic infarctions had been diagnosed antemortem.1-3 It can occur in a multitude of conditions, with general or local manifestations, and was often a clinical “blind CASE REPORT spot” during the process of diagnosis. However, splenic infarction must be considered in patients with hema- The patient was a 79-year-old man with degenera- tologic diseases or thromboembolic conditions.
    [Show full text]
  • Asplenia Vaccination Guide
    Stanford Health Care Vaccination Subcommitee Revision date 11/308/2018 Functional or Anatomical Asplenia Vaccine Guide I. PURPOSE To outline appropriate vaccines targeting encapsulated bacteria for functionally or anatomically asplenic patients. Routine vaccines that may also be indicated but not addressed here include influenza, Tdap, herpes zoster, HPV, MMR, and varicella.1,2,3 II. Background Functionally or anatomically asplenic patients should be vaccinated to decrease the risk of sepsis due to organisms such as Streptococcus pneumoniae, Haemophilus influenzae type B, and Neisseria meningitidis. Guidelines are based on CDC recommendations. For additional information, see https://www.cdc.gov/vaccines/schedules/hcp/imz/adult-conditions.html. III. Procedures/Guidelines1,2,3,6,7,8 The regimen consists of 4 vaccines initially, followed by repeat doses as specified: 1. Haemophilus b conjugate (Hib) vaccine (ACTHIB®) IM once if they have not previously received Hib vaccine 2. Pneumococcal conjugate 13-valent (PCV13) vaccine (PREVNAR 13®) IM once • 2nd dose: Pneumococcal polysaccharide 23-valent (PPSV23) vaccine (PNEUMOVAX 23®) SQ/IM once given ≥ 8 weeks later, then 3rd dose as PPSV23 > 5 years later.4 Note: The above is valid for those who have not received any pneumococcal vaccines previously, or those with unknown vaccination history. If already received prior doses of PPSV23: give PCV13 at least 1 year after last PPSV23 dose. 3. Meningococcal conjugate vaccine (MenACWY-CRM, MENVEO®) IM (repeat in ≥ 8 weeks, then every 5 years thereafter) 4. Meningococcal serogroup B vaccine (MenB, BEXSERO®) IM (repeat in ≥ 4 weeks) Timing of vaccination relative to splenectomy: 1. Should be given at least 14 days before splenectomy, if possible.
    [Show full text]
  • Peripheral Blood Cells Changes After Two Groups of Splenectomy And
    ns erte ion p : O y p H e f Yunfu et al., J Hypertens (Los Angel) 2018, 7:1 n o l A a DOI: 10.4172/2167-1095.1000249 c c n r e u s o s J Journal of Hypertension: Open Access ISSN: 2167-1095 Research Article Open Access Peripheral Blood Cells Changes After Two Groups of Splenectomy and Prevention and Treatment of Postoperative Complication Yunfu Lv1*, Xiaoguang Gong1, XiaoYu Han1, Jie Deng1 and Yejuan Li2 1Department of General Surgery, Hainan Provincial People's Hospital, Haikou, China 2Department of Reproductive, Maternal and Child Care of Hainan Province, Haikou, China *Corresponding author: Yunfu Lv, Department of General Surgery, Hainan Provincial People's Hospital, Haikou 570311, China, Tel: 86-898-66528115; E-mail: [email protected] Received Date: January 31, 2018; Accepted Date: March 12, 2018; Published Date: March 15, 2018 Copyright: © 2018 Lv Y, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Abstract Objective: This study aimed to investigate the changes in peripheral blood cells after two groups of splenectomy in patients with traumatic rupture of the spleen and portal hypertension group, as well as causes and prevention and treatment of splenectomy related portal vein thrombosis. Methods: Clinical data from 109 patients with traumatic rupture of the spleen who underwent splenectomy in our hospital from January 2001 to August 2015 were retrospectively analyzed, and compared with those from 240 patients with splenomegaly due to cirrhotic portal hypertension who underwent splenectomy over the same period.
    [Show full text]
  • Open Splenectomy Scott F
    Open Splenectomy Scott F. Gallagher, Larry C. Carey, Michel M. Murr Indications and Contraindications Indications ■ Trauma ■ Blood dyscrasias, e.g., idiopathic thrombocytopenic purpura ■ Symptomatic relief, e.g., Gaucher’s disease, chronic myeloid or lymphatic leukemia ■ Splenic cysts and tumors Contraindications ■ No absolute contraindications for splenectomy ■ Limited life expectancy and prohibitive operative risk Contraindications to ■ Previous open upper abdominal surgery Laparoscopic Splenectomy ■ Uncontrolled coagulation disorder ■ Very low platelet count (<20,000/100ml) ■ Massive splenic enlargement, i.e., spleen greater four times normal size or larger ■ Portal hypertension Preoperative Investigation and Preparation ■ Imaging studies to estimate the size of the spleen or extent of splenic injury and other abdominal injuries in trauma cases ■ Interpretation of bone marrow biopsy, peripheral blood smear, and ferrokinetics in coordination with a hematologist ■ Discontinue anticoagulants (such as aspirin, warfarin, clopidogrel and vitamin E) ■ Patients routinely given polyvalent pneumococcal vaccine, Haemophilus influenzae b conjugate vaccines and meningococcal vaccines on the same day at least 10–14days prior to splenectomy (given postoperatively in trauma cases) ■ Prophylactic antibiotics (cefazolin or cefotetan) ■ Perioperative DVT prophylaxis ■ Perioperative steroids should be administered to patients on long-term steroid therapy 954 SECTION 7 Spleen Procedure STEP 1 The standard supine position is employed with an optional small roll/bump under the left flank. The patient should be well secured to the operating table should it become necessary to tilt the table to improve visualization of the operative field. Mechanical retractors greatly enhance exposure and the primary surgeon should stand on the right side of the patient; the first assistant opposite the surgeon on the left side of the patient.
    [Show full text]
  • Public Use Data File Documentation
    Public Use Data File Documentation Part III - Medical Coding Manual and Short Index National Health Interview Survey, 1995 From the CENTERSFOR DISEASECONTROL AND PREVENTION/NationalCenter for Health Statistics U.S. DEPARTMENTOF HEALTHAND HUMAN SERVICES Centers for Disease Control and Prevention National Center for Health Statistics CDCCENTERS FOR DlSEASE CONTROL AND PREVENTlON Public Use Data File Documentation Part Ill - Medical Coding Manual and Short Index National Health Interview Survey, 1995 U.S. DEPARTMENT OF HEALTHAND HUMAN SERVICES Centers for Disease Control and Prevention National Center for Health Statistics Hyattsville, Maryland October 1997 TABLE OF CONTENTS Page SECTION I. INTRODUCTION AND ORIENTATION GUIDES A. Brief Description of the Health Interview Survey ............. .............. 1 B. Importance of the Medical Coding ...................... .............. 1 C. Codes Used (described briefly) ......................... .............. 2 D. Appendix III ...................................... .............. 2 E, The Short Index .................................... .............. 2 F. Abbreviations and References ......................... .............. 3 G. Training Preliminary to Coding ......................... .............. 4 SECTION II. CLASSES OF CHRONIC AND ACUTE CONDITIONS A. General Rules ................................................... 6 B. When to Assign “1” (Chronic) ........................................ 6 C. Selected Conditions Coded ” 1” Regardless of Onset ......................... 7 D. When to Assign
    [Show full text]
  • Splenectomy for Splenomegaly and Secondary Hypersplenism
    World J. Surg. 9, 437--443, 1985 1985 by the Soci~t~ lnternationale de Chirurgie Splenectomy for Splenomegaly and Secondary Hypersplenism William W. Coon, M.D. Department of Surgery, The University of Michigan Hospitals, Ann Arbor, Michigan, U.S.A. Splenomegaly and secondary hypersplenism may be associ- The separation of hypersplenism into primary ated with acute and chronic infections, autoimmune states, and secondary categories is also imprecise. The portal hypertension or splenic vein thrombosis, and a diseases usually included under "primary" hyper- number of infiltrative and neoplastic conditions involving splenism are those in which the fundamental defect the spleen. Our experience and that of others with these is thought to be related to a congenital or acquired various conditions demonstrates that the decision to per- alteration in cell membrane or structure of form splenectomy should be based on well-defined and hematopoietic cells (idiopathic thrombocytopenic often strictly limited indications. Except for idiopathic purpura, acquired hemolytic anemia, some of the splenomegaly, the presence and severity of secondary congenital hemolytic anemias, etc.). hypersplenism or severely symptomatic splenomegaly This discussion will be confined to selected enti- should be well documented. In each case, the potential for ties usually considered to be associated with "sec- palliation and known mean duration of expected response ondary" hypersplenism in which splenomegaly and must be weighed against the increased morbidity and altered splenic
    [Show full text]
  • Comparison of Different Methods of Splenic Hilar Lymph Node Dissection
    Ji et al. BMC Cancer (2016) 16:765 DOI 10.1186/s12885-016-2814-z RESEARCH ARTICLE Open Access Comparison of different methods of splenic hilar lymph node dissection for advanced upper- and/or middle-third gastric cancer Xin Ji†, Tao Fu†, Zhao-De Bu, Ji Zhang, Xiao-Jiang Wu, Xiang-Long Zong, Zi-Yu Jia, Biao Fan, Yi-Nan Zhang and Jia-Fu Ji* Abstract Background: Surgery for advanced gastric cancer (AGC) often includes dissection of splenic hilar lymph nodes (SHLNs). This study compared the safety and effectiveness of different approaches to SHLN dissection for upper- and/or middle-third AGC. Methods: We retrospectively compared and analyzed clinicopathologic and follow-up data from a prospectively collected database at the Peking University Cancer Hospital. Patients were divided into three groups: in situ spleen- preserved, ex situ spleen-preserved and splenectomy. Results: We analyzed 217 patients with upper- and/or middle-third AGC who underwent R0 total or proximal gastrectomy with splenic hilar lymphadenectomy from January 2006 to December 2011, of whom 15.2 % (33/ 217) had metastatic SHLNs, and from whom 11.4 % (53/466) of the dissected SHLNs were metastatic. The number of harvested SHLNs per patient was higher in the ex situ group than in the in situ group (P = 0.017). Length of postoperative hospital stay was longer in the splenectomy group than in the in situ group (P =0.002)ortheex situ group (P < 0.001). The splenectomy group also lost more blood volume (P = 0.007) and had a higher postoperative complication rate (P = 0.005) than the ex situ group.
    [Show full text]
  • OPEN FORUM Pros and Cons of Splenectomy in Patients
    Leukemia (2001) 15, 465–467 2001 Nature Publishing Group All rights reserved 0887-6924/01 $15.00 www.nature.com/leu OPEN FORUM Pros and cons of splenectomy in patients with myelofibrosis undergoing stem cell transplantation Z Li and HJ Deeg Fred Hutchinson Cancer Research Center and the University of Washington, Seattle, WA, USA During fetal development, the spleen is a major hemopoietic the possible immunological consequences of splenectomy, organ. In the adult human, this task is relinquished to the bone and discuss factors that may influence the decision on marrow. However, under the stress of certain pathologic con- ditions, extramedullary hemopoiesis may again occur in the splenectomy in the management of myelofibrosis. spleen. This is especially true for diseases of the marrow, in particular, myeloproliferative disorders such as agnogenic myeloid metaplasia, which is associated with severe fibrosis of Clinical controversies the marrow space. At the same time, the spleen sequesters blood cells and contributes to peripheral blood cytopenias, Surgical splenectomy and splenic irradiation have been part which may improve following splenectomy. However, success is unpredictable, and the operative mortality of splenectomy is of the management of AMM for two reasons: firstly, to relieve on the order of 10%. As a growing number of patients undergo symptoms associated with splenomegaly, and secondly, to hemopoietic stem cell transplantation as definitive therapy for possibly slow disease progression, although this notion is not myelofibrosis, the decision on splenectomy has additional well supported by data. In fact, some reports suggest that in ramifications since the spleen plays an important role in the patients with AMM, splenectomy is associated with an kinetics of engraftment of donor cells and in immune reconsti- increased risk of blast transformation.4 Tefferi and colleagues2 tution.
    [Show full text]
  • Icd-9-Cm (2010)
    ICD-9-CM (2010) PROCEDURE CODE LONG DESCRIPTION SHORT DESCRIPTION 0001 Therapeutic ultrasound of vessels of head and neck Ther ult head & neck ves 0002 Therapeutic ultrasound of heart Ther ultrasound of heart 0003 Therapeutic ultrasound of peripheral vascular vessels Ther ult peripheral ves 0009 Other therapeutic ultrasound Other therapeutic ultsnd 0010 Implantation of chemotherapeutic agent Implant chemothera agent 0011 Infusion of drotrecogin alfa (activated) Infus drotrecogin alfa 0012 Administration of inhaled nitric oxide Adm inhal nitric oxide 0013 Injection or infusion of nesiritide Inject/infus nesiritide 0014 Injection or infusion of oxazolidinone class of antibiotics Injection oxazolidinone 0015 High-dose infusion interleukin-2 [IL-2] High-dose infusion IL-2 0016 Pressurized treatment of venous bypass graft [conduit] with pharmaceutical substance Pressurized treat graft 0017 Infusion of vasopressor agent Infusion of vasopressor 0018 Infusion of immunosuppressive antibody therapy Infus immunosup antibody 0019 Disruption of blood brain barrier via infusion [BBBD] BBBD via infusion 0021 Intravascular imaging of extracranial cerebral vessels IVUS extracran cereb ves 0022 Intravascular imaging of intrathoracic vessels IVUS intrathoracic ves 0023 Intravascular imaging of peripheral vessels IVUS peripheral vessels 0024 Intravascular imaging of coronary vessels IVUS coronary vessels 0025 Intravascular imaging of renal vessels IVUS renal vessels 0028 Intravascular imaging, other specified vessel(s) Intravascul imaging NEC 0029 Intravascular
    [Show full text]
  • Diffuse Large B-Cell Lymphoma with Distinctive Patterns of Splenic and Bone Marrow Involvement: Clinicopathologic Features of Two Cases
    Modern Pathology (2005) 18, 495–502 & 2005 USCAP, Inc All rights reserved 0893-3952/05 $30.00 www.modernpathology.org Diffuse large B-cell lymphoma with distinctive patterns of splenic and bone marrow involvement: clinicopathologic features of two cases William G Morice, Fausto J Rodriguez, James D Hoyer and Paul J Kurtin Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA Two unusual cases of large B-cell lymphoma with predominant splenic and bone marrow (BM) involvement and similar clinical and histopathologic features are described. Both patients presented with nonspecific constitutional symptoms, unexplained cytopenias, and splenomegaly. Splenectomy revealed diffuse red pulp involvement by large B-cell lymphoma. The perisplenic lymph nodes were also involved diffusely with effacement of normal nodal architecture, excluding a diagnosis of intravascular large B-cell lymphoma. BM biopsies revealed striking erythroid hyperplasia without overt morphologic evidence of involvement by lymphoma. Immunoperoxidase staining of the marrow biopsies with antibodies to CD20 and erythroid- associated antigens revealed involvement by large B-cell lymphoma morphologically resembling the early pronormoblasts. In both cases there was prominent, but not exclusive, intravascular/intrasinusoidal lymphomatous marrow infiltration. These cases represent an unusual variant of large B-cell lymphoma with distinctive patterns of splenic and BM involvement. Furthermore, they underscore the difficulties in identifying intrasinusoidal
    [Show full text]
  • Reappraisal of Thymectomy in Human Renal Allotransplantation
    Keio J. Med. 21: 255-266, 1972 REAPPRAISAL OF THYMECTOMY IN HUMAN RENAL ALLOTRANSPLANTATION HIROSHI NAKAMURA*, HIROSHI YOSHIMATSU**, MASAHARU TSUCHIYA***, NORIKAZU TAMAOKI****, and MOTOAKI ITO*T *** Department of Urology, Tokyo Electric Power Hospital, Tokyo; Departments of Surgery, Internal Medicine, Pathology and Radiology, School of Medicine. Keio University, Tokyo (Received for publication September 15, 1972) Thymectomy has been used in many patients in conjunction with other im munosuppressive agents in Denver, Coloradot-4 and in Cleveland, Ohio 5,6 Starzl and his associates4 evaluated thymectomy as an immunosuppressive measure in a group of 46 patients treated from 4 to 5112years ago. Before transplantation the thymus gland was removed transthoracically in 24 randomly selected recipients whose subsequent fates were compared with those of 22 others who dip not have thymectomy. Patients with thymic excision did not have a better survival nor superior renal function, but their allografts tended to have fewer and less severe histopathologic abnormalities when examined long after transplantation. In Denver, thymectomies were performed through an incision in the second or third left intercostal space. Care was taken to excise the cervical thymic tissue . Yoshimatsu7 has approached the thymus through the neck, accomplishing what seemed to be a complete thymectomy in 120 patients. In none of them have there been any surgical complications resulting from thymectomy. Since the technique of thymectomy has been standardized, the thymuses of 5 recipient patients have been transcervically excised, either prior to or after renal allografting for the * Department of Urolo v . Tokyo Electric Power Hncnitnl. Tnkvn ** Department of Surgery , School of Medicine, Keio University.
    [Show full text]
  • Disadvantages of Complete No. 10 Lymph Node Dissection in Gastric Cancer and the Possibility of Spleen-Preserving Dissection: Review
    J Gastric Cancer. 2020 Mar;20(1):1-18 https://doi.org/10.5230/jgc.2020.20.e8 pISSN 2093-582X·eISSN 2093-5641 Review Article Disadvantages of Complete No. 10 Lymph Node Dissection in Gastric Cancer and the Possibility of Spleen-Preserving Dissection: Review Tetsuro Toriumi , Masanori Terashima Division of Gastric Surgery, Shizuoka Cancer Center, Shizuoka, Japan Received: Aug 16, 2019 ABSTRACT Accepted: Jan 17, 2020 Correspondence to Splenic hilar lymph node dissection has been the standard treatment for advanced proximal Masanori Terashima gastric cancer. Splenectomy is typically performed as part of this procedure. However, Division of Gastric Surgery, Shizuoka Cancer splenectomy has some disadvantages, such as increased risk of postoperative complications, Center, 1007 Shimonagakubo, Nagaizumi-cho, especially pancreatic fistula. Moreover, patients who underwent splenectomy are vulnerable Sunto-gun, Shizuoka 411-8777, Japan. E-mail: [email protected] to potentially fatal infection caused by encapsulated bacteria. Furthermore, several studies have shown an association of splenectomy with cancer development and increased risk of Copyright © 2020. Korean Gastric Cancer thromboembolic events. Therefore, splenectomy should be avoided if it does not confer Association a distinct oncological advantage. Most studies that compared patients who underwent This is an Open Access article distributed under the terms of the Creative Commons splenectomy and those who did not failed to demonstrate the efficacy of splenectomy. Based Attribution Non-Commercial License (https:// on the results of a randomized controlled trial conducted in Japan, prophylactic dissection creativecommons.org/licenses/by-nc/4.0) with splenectomy is no longer recommended in patients with gastric cancer with no invasion which permits unrestricted noncommercial of the greater curvature.
    [Show full text]