DOI: 10.3897/folmed.68.e155005

Authors: Wulyo Rajabto, Lugyanti Sukrisman, Agnes Stephanie Harahap, Maria Pyrhadistya, Ainun Safitri

Abstract: Gastric diffuse large B-cell lymphoma (DLBCL) comprises most of all gastrointestinal lymphomas, accounting for approximately 55%–65% of all cases. This condition predominantly affects male patients and those older than 50 years and is usually aggressive. The clinical presentations are nonspecific and can mimic other diseases. In this report, we present a case of a 66-year-old male patient with a history of hematemesis and melena, with significant weight loss for 3 months. Esophagogastroduodenoscopy (EGD) revealed multiple stomach ulcers. A biopsy taken during EGD, which was followed by immunohistochemical staining, confirmed the diagnosis of non-Hodgkin lymphoma, specifically germinal center B-cell (GCB)–subtype DLBCL. A positron emission tomography (PET) scan was performed, revealing the involvement of the mesenteric lymph nodes and an infiltrative lesion that extended from the stomach to the pancreas. Based on the Ann Arbor staging system, the diagnosis was identified to be stage IV gastric DLBCL. Following diagnosis, we administered rituximab, cyclophosphamide, hydroxydaunorubicin, vincristine, and prednisone (R-CHOP) to the patient.

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DOI: 10.3897/folmed.67.e156417

Authors: Alessandro Gozzetti

Abstract: NA

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DOI: 10.3897/folmed.67.e143457

Authors: Rahmat Cahyanur, Muhammad Ikhsan, Shabrina Tadjoedin, Devi Nurfadila Fani

Abstract: Introduction: The carotid tunica intima-media thickness (cIMT) is an early marker of atherosclerosis and associated with an increased risk of cardiovascular diseases. Endothelial dysfunction also contributed with the increased cardiovascular risk in thalassemia caused by iron accumulation, reduced nitric oxide, and increased lipid peroxidation. Studies about atherosclerosis markers in thalassemia patients show inconsistent results. Aim: This research assesses cIMT in transfusion-dependent thalassemia patients and examines its relationship with clinical and laboratory parameters. Materials and methods: This was a cross-sectional study that was conducted from March to May 2024, in the Therapy and Thalassemia Clinics, Universitas Indonesia Hospital. Ultrasound cIMT measurements were recorded for both the left and right distal common carotid artery walls, 5 mm proximal to the bifurcation. The cIMT diameters were collected from each wall and mean thickness values from both sides. Results: This study included 25 adult thalassemia patients who were diagnosed with transfusion-dependent thalassemia. Most subjects were male, with a median age of 25 years, and had an underweight BMI. Patients with underweight BMI had thicker cIMT, both in mean and maximum diameter (p=0.008 and p=0.011, respectively). Conclusion: Additionally, a transfusion frequency of ≥3 per month had a greater maximum diameter cIMT (p=0.046). A moderate positive correlation was observed between average ferritin levels and maximum intima-media thickness (r=0.402, p=0.046).

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DOI: 10.3897/folmed.65.e98404

Authors: Milan Jagurinoski, Yanitsa Davidkova, Milena Stojcov-Jagurinoska, Gueorgui Balatzenko, Branimir Spassov, Margarita Guenova

Abstract: Aim: To compare the main features of patients with secondary acute myeloid leukemias (AMLs) after post-myelodysplastic syndrome (AML-post-MDS) or post-myeloproliferative neoplasms (AML-post-MPN) and myeloid blast crisis of chronic myeloid leukemia (CML-BC) vs. de novo AMLs with myelodysplastic characteristics (dn-AML-MDS). Materials and methods: Bone marrow/peripheral blood samples of 94 patients with secondary AMLs (30 with AML-post-MDS, 20 with AML-post-MPN, and 14 with CML-BC) and 30 with dn-AML-MDS were included. Demographic, morphological, phenotypic, cytogenetic, and survival data were analyzed. Results: Comparative analysis showed no differences in sex and age, except for the younger age in CML-BC (p=0.005). Leukocytosis was a prevalent feature of CML-BC vs. AML-post-MPN, AML-post-MDS and dn-AML-MDS (p<0.001). At leukemia onset, thrombocytopenia was characteristic of AML-post-MDS and dn-AML-MDS whereas normal PLT counts were found in AML-post-MPN and CML-BC (p=0.001). Dysplasia in ≥2 lineages was observed in almost all dn-AML-MDS (96.8%) and AML-post-MDS (100%) compared to AML-post-MPN (33.3%) and none of the CML-BC (p=0.001). Aberrant co-expression of 1-4 lymphoid-associated markers was detected in 67.5% of all patients, including CD7, CD19, CD56, and CD22. We found chromosome aberrations in 57.8% of patients, more frequently in dn-AML-post-MDS than in AML-post-MPN, CML-BC, and AML-post-MDS. While NPM1 mutations distribution was similar in the two MDS-related AML groups, FLT3-ITD was higher in AML-post-MDS (26.3%) than in dn-AML-MDS (4.5%) (p=0.049). Regarding EVI1, CML-BC (80%) and AML-post-MPN (37.5%) showed higher incidence of gene overexpression compared to AML-post-MDS (13.3%) and dn-AML-MDS (5.0%) (p=0.001). Median time to leukemia was significantly shorter in AML-post-MDS (4.80±1.04 months) than in AML-post-MPN (20.3±2.86 months) and CML-BC (34.7±16.3 months) (p=0.008), and median overall survival was poor in all groups. Conclusions: Similarities and differences between patients with secondary AMLs may represent different biology which translates into different clinical course and may require different therapeutic approach in future.

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DOI: 10.3897/folmed.65.e75414

Authors: Hristina A. Ivanova, Zhanet Grudeva-Popova, Tanya Deneva, Silvia Tsvetkova, Nonka Mateva

Abstract: Introduction: Osteopenia and osteoporosis are well-known hemophilia A comorbidities. The pathogenesis of bone turnover alteration resulting in reduced bone mass includes impaired osteoblastic differentiation and disinhibition of RANKL-induced osteoclastogenesis as a result of a low FVIII level. Aim: To evaluate the bone mineral density (BMD) in adult patients with severe hemophilia A and assess a possible correlation with the bone remodeling biomarkers OPG/RANKL, CTX-1, osteocalcin, and Vit D. Materials and methods: 28 male subjects with severe hemophilia A and 33 age-matched controls were recruited. The biomarkers were tested with the ELISA assay and BMD with DEXA of the lumbar spine (LS) and total hip (TH). Results: The patients had lower LS-BMD (−0.955±0.145 vs. 1.118±0.079, p=0.05) and TH-BMD (−0.840±0.147 vs. 0.951±0.075, p=0.05) than those of the controls. The TH T-scores were −1.41±0.91 vs. 0.4±0.49 (p=0.05) and the LS T-scores −1.16±1.046 vs. 0.14±0.72 (p=0.05). 66.6% of patients under 50 years had osteopenia and 8.3% had osteoporosis. Fifty percent of those over 50 years old had osteopenia and 20% had osteoporosis. We found significantly higher OPG levels (123.69±107.05 vs. 41.98±18.95, p=0.05) than that in controls and lower sRANKL levels (23.49±29.39 vs. 131.32±201.27, p=0.05) and sRANKL/OPG ratio (0.27±0.35 vs. 5.28±10.01, p=0.05) than those in controls. A positive correlation was found between sRANKL and the BMD T-score of lumbar spine (p=0.001) in the patient group. Conclusions: sRANKL level and ratio can be used as predictors of low BMD.

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DOI: 10.3897/folmed.63.e55651

Authors: Alexey V. Shabunin, Dmitry N. Grekov, Ivan N. Lebedinsky, Andrey I. Evsikov, Serghei Covantev, Varvara A. Afanaseva

Abstract: Adrenal gland incidentaloma (incidental – sudden, accidental) is a mass of the adrenal gland(s), accidentally detected by an instru-mental examination conducted for other reasons. The frequency of detection of this pathology based on computer tomography of the abdominal organs is 0.5%–2%. In most cases, the mass is represented by adrenocortical adenomas without hormonal secretion. It is an extremely rare case (less than 1% of all cases) when the adrenal incidentaloma is a primary adrenal lymphoma, which accounts for 1% of all non-Hodgkin lymphomas and 3% of all extranodal lymphomas with a few cases reported in the literature. In our article, we present a case of left adrenal incidentaloma of the adrenal gland, which, during further observation and examination, increased in size, which was the reason for performing laparoscopic adrenalectomy. According to the results of the histological examination, the mass turned out to be diffuse large B-cell lymphoma.

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DOI: 10.3897/folmed.62.e51402

Authors: Branimir Spassov, Donka Vassileva, Svetoslav Nikolov, Penka Ganeva, Gueorgui Balatzenko, Margarita Guenova

Abstract: Introduction: Primary gastric diffuse large B cell lymphoma (PG-DLBCL) is the most common histological subtype of primary gastric lymphoma. The standard of care of PG-DLBCL patients is the combination rituximab-based immunochemotherapy (R-CHOP). Re-cently, different host-related factors have been shown to have significant prognostic significance in non-Hodgkin lymphoma. However, data regarding their prognostic contribution to PG-DLBCL are limited. Aim: To assess the prognostic impact of a panel of simple, cost-effective laboratory variables which are easy to apply in routine labora-tory use for R-CHOP-treated PG-DLBCL patients in an attempt to identify those among them that are high-risk category.Materials and methods: We retrospectively assessed the possible prognostic impact of different laboratory markers in 42 R-CHOP treated PG-DLBCL patients treated between 2004 and 2014 and followed at a single institution.Results: The estimated 5-year overall (OS) and progression-free survival (PFS) of the whole group were 80.9% and 78%, respectively. The absolute monocyte and platelet counts in univariate analysis predicted PFS and OS when analyzed as continuous and dichotomized variables. On multivariate analysis performed with factors included in the stage-modified International Prognostic Index (m-IPI), the absolute monocyte and platelet counts remained independent predictors of PFS and OS. Therefore, the absolute monocyte and platelet counts were combined to generate a prognostic index that identified patients with an especially poor overall survival. Conclusions: This prognostic index was independent of the m-IPI and could provide additional prognostic information for better stratification of these patients.

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DOI: 10.3897/folmed.62.e50321

Authors: Vasko Graklanov, Veselin Popov, Ralitsa Raycheva

Abstract: Aim: То investigate the serum levels of vitamin D in newly diagnosed patients with multiple myeloma.Patients and methods: In this study we measured the serum levels of vitamin D in 37 patients (19 women, 18 men) at a median age of 68 years and a diagnosis of MM according to the International Myeloma Working Group (IMWG) criteria. The immunoassay tests used for the quantification of 25 (OH) – Vitamin D were original ELISA kits Immundiagnostic and the measurement was done before starting the treatment.Results: Serum levels below the optimum (<30 ng/ml) were recorded in all 37 patients. The median value of vitamin D was 4.3±6.5 mg/ml, the maximum value measured was 24.7 mg/ml, which is below the lower limit of the reference value for deficiency.Conclusions: In this study, we found extremely low serum vitamin D levels in most of the newly diagnosed MM patients.

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