Fontanilla, Crista Mae F.

1.) Unexpected association between diseases and symptom Simultaneous presentation of Kaposi sarcoma and HHV8-associated large B-cell lymphoma in the same lymph node: A rare diagnosis in an HIV-negative patient. Abstract Patient: Female, 18 Final Diagnosis: Simultanous presentation of Kaposi Sarcoma and Lymphoma Symptoms: - Medication: - Clinical Procedure: - Specialty: Oncology. OBJECTIVE: Rare disease. BACKGROUND: KSHV/HHV-8 is associated with Kaposi's sarcoma (KS) as well as with a few categories of lymphoproliferative diseases, mostly occurring in patients with HIV infection/AIDS. Although the association between lymphomas and Kaposi's sarcoma has been described, the simultaneous presence of the 2 entities within the same organ is rare and mainly associated with HIV/ AIDS. CASE REPORT: We report a case of simultaneous occurrence of Kaposi's sarcoma and large B-cell lymphoma in the same lymph node in a 18-year-old African woman who was HIV-negative. We found concurrent infection with Kaposi's sarcoma herpes virus (KSHV) and Epstein-Barr virus (EBV), confirmed by PCR amplification of DNA obtained from distinct tumor areas selected in the paraffin block. CONCLUSIONS: The possibility of occurrence of 2 lesions with distinct features in the same organ may be unexpected for pathologists performing fine-needle aspiration cytology (FNAC) evaluation but must be considered, even in HIV-negative individuals, despite its rare occurrence, as was demonstrated by this case.

2.) Unexpected event in the course of observing and treating a patient Sudden blast crisis in a chronic myeloid leukemia patient during imatinib therapy. Abstract Imatinib mesilate (IM) is the first line therapy for chronic myeloid leukemia (CML) patients in chronic phase. Although it offers a complete cytogenetic response (CCyR) in a majority of patients, there still are some rare cases in which a sudden blast crisis (SBC) evolves. The mechanism of this unexpected event is not yet completely understood. We present the case of a female patient who developed a SBC while being under IM therapy. We do not know for sure which is the role of IM in this event, but current available data suggest that this drug may have a permissive effect on the evolution of some aggressive subclones in the context of restored normal cell population.

3.) Findings that shed new light on the possible pathogenesis of a disease or an adverse effect LRG1 promotes angiogenesis by modulating endothelial TGF- signalling. Abstract Aberrant neovascularization contributes to diseases such as cancer, blindness and atherosclerosis, and is the consequence of inappropriate angiogenic signalling. Although many regulators of pathogenic angiogenesis have been identified, our understanding of this process is incomplete. Here we explore the transcriptome of retinal microvessels isolated from mouse models of retinal disease that exhibit vascular

pathology, and uncover an upregulated gene, leucine-rich alpha-2-glycoprotein 1 (Lrg1), of previously unknown function. We show that in the presence of transforming growth factor-1 (TGF-1), LRG1 is mitogenic to endothelial cells and promotes angiogenesis. Mice lacking Lrg1 develop a mild retinal vascular phenotype but exhibit a significant reduction in pathological ocular angiogenesis. LRG1 binds directly to the TGF accessory receptor endoglin, which, in the presence of TGF-1, results in promotion of the pro-angiogenic Smad1/5/8 signalling pathway. LRG1 antibody blockade inhibits this switch and attenuates angiogenesis. These studies reveal a new regulator of angiogenesis that mediates its effect by modulating TGF- signalling.

4.) Unique or rare features of a disease Fever of unknown origin as the first manifestation of colonic pathology. Abstract

Fever of unknown origin (FUO) is an entity caused by more than 200 diseases. Haematologic neoplasms are the most common malignant cause of FUO. Fever as a first symptom of colonic tumour pathology, both benign and malignant, is a rare form of presentation. Our work is a descriptive study of a series of 23 patients with colonic tumoral pathology who presented with fever of unknown origin. The mean age was 67.6 years; 56.5% of patients were men and 43.5% were women. Primary malignant neoplasia was the most common diagnosis. Blood cultures were positive in 45% of the samples. Coagulase-negative staphylococci were the most common cause of bacteraemia. Nine of 10 faecal occult blood tests performed were positive. Fever secondary to colon neoplasms, both benign and malignant, usually presents with a bacteraemic pattern, with positive results for blood-culture tests in a high percentage of cases.

5.) Unique therapeutic approaches Therapeutic effect of hyperbaric oxygen on inclusion body myositis. Abstract An inflammatory myopathy, inclusion body myositis (IBM) presents with progressive muscle weakness against a background of elevated creatine kinase and diffuse endomysial damage. Typically occurring in patients greater than 50 years of age, it is commonly misdiagnosed as polymyositis or other rheumatological disease and is often ineffectively treated with steroids [1]. The approach to IBM is frequently a clinical challenge due to its unique and often aberrant response to common treatment modalities. Here we report an apparent improvement in the clinical course of and associated laboratory findings in a patient with co-existing IBM following the use of hyperbaric oxygen therapy as an adjunct for managing ischemic colitis.

6.) Positional or quantitative variation of the anatomical structure Failure of supraclavicular block under ultrasound guidance: clinical relevance of anatomicalvariation of cervical vessels. Abstract We describe a case with partial analgesia after ultrasound-guided supraclavicular block for elbow surgery. The failure of the block was caused by the limited spread of local anesthetic because of blockage by a vessel (either transverse cervical artery or dorsal scapular artery) running through the brachial plexus. Anesthesiologists should be aware that cervical anatomy is complex and has anatomical variations. Thus, careful ultrasound screening of anatomical structure, especially using color Doppler, is important in performing brachial plexus block.