Adrenal Crisis and Disseminated Intravascular Coagulation Associated With Disseminated Carcinomatosis of the Bone Marrow From Gastric Cancer

Gastric cancer is the third leading cause of cancer deaths worldwide. Disseminated carcinomatosis of bone marrow (DCBM) originating from gastric cancer is rare and associated with poor prognosis. We present the first reported case of gastric adenocarcinoma with DCBM leading to concomitant disseminated intravascular coagulation (DIC) and adrenal crisis refractory to treatment. Computerized tomography of the chest, abdomen and pelvis showed diffuse sclerosis of the axial and proximal appendicular skeleton, suggestive of metastatic disease. Bone marrow biopsy demonstrated infiltrative signet ring cells, consistent with metastatic adenocarcinoma from gastric primary. Laboratory tests showed severe anemia, thrombocytopenia, and coagulopathy, compatible with DIC.

Correlation Between Anti-Topoisomerase I and C-Reactive Protein Antibody Level with Modified Rodnan Skin Score On Systemic Sceloris Patients

A B S T R A C TSystemic sclerosis is characterized by extensive and progressive organfibrosis processes leading to organ failure and death. Modified Rodnan SkinScore (mRSS) had been used as a clinical parameter of skin fibrosis. Anti-topoisomerase I and C-Reactive Protein (CRP) are potential biomarkers forassessing disease activity. The study was performed to determine theassociation of anti-topoisomerase I and CRP antibodies with mRSS values.We performed an observational analytic study based on primary andsecondary data. Systemic sclerosis patient sera data was obtained fromDewi S et al's study, taken from May 2015 to June 2017. Serum Anti -topoisomerase I antibody and CRP level analysis were performed inDecember 2017.Fifty six samples analyzed. Fifty four subjects (96.4%) out of 56 subjects arewomen with an average age of 37 ± 11 years, 41 subjects (73.3%) hasdisease duration over 2 years, 34 subjects (60.7%) has difuse systemicsclerosis, 41 subjects (73.3%) in steroid therapy and 50 subjects (89.3%) inmethotrexate therapy. The statistical analysis showed no correlationbetween anti-topoisomerase I antibody and CRP levels with mRSS values(r = 0.205, p = 0.064; r = -0.134, p = 0.167), but there was a positivecorrelation of anti-topoisomerase I antibody level with mRSS (r = 0,422 p =0,007) and negative correlation between CRP level and mRSS (r = -0,511 p= 0,001) in diffuse sclerosis systemic.From this study we concluded that anti-topoisomerase I antibody and CRPlevel were not correlated with mRSS, but in patient with diffuse systemicsclerosis there was a positive correlation of anti-topoisomerase I antibodylevel with mRSS and negative correlation between CRP level and mRSS.

Sclerosing melanocytic lesions (sclerosing melanomas with nevoid features and sclerosing nevi with pseudomelanomatous features) – an analysis of 90 lesions

Background Sclerosing melanocytic lesions, which are characterized by either focal or diffuse sclerosis in the dermal component and atypical proliferation of predominantly nevoid melanocytes, remain poorly defined. Our aim was to analyze systematically their morphologic spectrum, especially the distinction between sclerosing melanocytic nevus and sclerosing melanoma, which has not been well documented. Patients and methods We collected 90 sclerosing melanocytic lesions, occurring in 82 patients (49 male, 33 female; age range from 21 to 89 years). A four probe fluorescent in situ hybridization (FISH) assay was performed in 41 lesions to substantiate the diagnosis of sclerosing melanomas. Results A prominent full-thickness pagetoid spread of melanocytes was identified in 44 (48%) lesions, and a melanoma in situ adjacent to the sclerosis in 55 (61%) lesions. In the intrasclerotic component, maturation was absent in 40 (44%) and mitotic figures were identified in 18 (20%) lesions. Of the 90 lesions, 26 (29%) were diagnosed morphologically as nevi and 64 (71%) as melanomas (Breslow thickness from 0.4 to 1.8 mm), including 45 (50%) melanomas with an adjacent nevus. A four-probe FISH assay was positive in the sclerotic component in 14 of 25 lesions diagnosed morphologically as melanomas and none of 16 nevi. A sentinel lymph node biopsy was performed for 17 lesions and was negative in all cases. Conclusions Sclerosing melanocytic lesions form a morphologic spectrum and include both nevi and melanomas. The pathogenesis of sclerosis remains obscure but seems to be induced by melanocytes or an unusual host response in at least a subset of lesions.

Ex Vivo Coronary Angiography of a Donor Heart in the Organ Care System

The international demand for donor hearts for transplantation is steadily increasing. Thus, longer transportation distances and explantation from sites with limited abilities for preexplantation diagnostics have to be considered. The development of the Organ Care System� (OCS) (TransMedics, Andover, MA, USA) may extend the extracorporeal period, with the possibility to constantly evaluate and interact during organ transport. One of the potential advantages of the OCS� is the ability to even perform coronary angiography of the donor heart, if a preexplantation angiography evaluation is not possible at the donor hospital and if significant evidence for coronary artery disease in the donor heart becomes known, because of the donor's medical history or after palpation of sclerotic coronary ostia. In this report, we present the first ex vivo coronary angiography evaluation of a potential donor heart that was performed in the OCS�. Upon explantation of the donor heart, sclerosis of the left coronary artery was palpated. After reaching the implantation site, a coronary angiography was performed by placing the OCS� on a catheterization table and inserting a 6F sheath into the access site of the OCS�. A 6F guide catheter was used to intubate the left coronary ostium. Injection of contrast agent led to strong contrast for visualization of the left coronary system. This procedure allowed sufficient assessment of the coronary arteries, which showed a slight diffuse sclerosis without any significant stenosis. This report demonstrates the advantage of the OCS� in the complex assessment of donor hearts after explantation. While the donor heart is still in the OCS�, not only is it possible to measure metabolic parameters and pressures, but even coronary angiography is feasible. With the increasing international demand for donor organs, such ex vivo examinations might play a more important role, because longer transportation distances can be accepted and organs from suboptimal donors without preexplantation diagnostics may be considered at donor sites with limited diagnostic options.