Acute Hepatitis A Induction of Precursor B-Cell Acute Lymphoblastic Leukemia: A Causal Relationship?

Background

Precursor B-cell acute lymphoblastic leukemia accounts for 2% of all lymphoid neoplasms in the United States and occurs most frequently in childhood, but can also occur in adults with a median age of 39 years. It is more commonly seen in males and in Caucasians.

Case Report

We present a case of a 51-year-old Caucasian female with the development of precursor B-cell acute lymphoblastic leukemia after suffering acute hepatitis A 4 weeks prior to her diagnosis. She presented with malaise for a month without spontaneous bruising/bleeding, infections, or B-symptoms, such as fevers, night sweats, or unintentional weight loss.

Conclusion

Nonspecific viral transformation of bone marrow has been discussed in the literature, but we specifically describe hepatitis A-induced adult-onset precursor B-cell acute lymphoblastic leukemia, which is the first reported case in the literature.Key Words: Acute hepatitis A, Precursor B-cell acute lymphoblastic leukemia, Epstein-Barr virus, Adult-onset ALL, Hepatitis A-induced aplastic anemia     

A rare cause of drug-induced hepatitis in an immunocompromised patient and the role of glutathione

The Food and Drug Administration (FDA) has issued a warning on numerous herbal drugs, including many popular products at General Nutrition Centers (GNC), regarding unstudied hepatotoxicity. There have been recent reports of GNC products such as hydroxycut and herbalife, causing drug-induced hepatitis. Herbal medications are over-the-counter products and are not investigated thoroughly by the FDA. Given that the mostcommon outpatient laboratory abnormality is elevated liver transaminases, a sign of hepatocellular toxicity; it is not surprising that some of these products end up causing hepatic dysfunction, especially when taken in large volume. There are numerous herbal supplements that are hepatotoxic, however, these medications have a much more significant effect in human immunodeficiency virus (HIV)/ acquired immune deficiency syndrome patients, which is secondary to depleted glutathione. We present a rare case of drug induced hepatitis secondary to herbal medications used to treat HIV and elucidate the role of glutathione depletion in immunocompromised patients.     

A diagnostic dilemma: metastatic testicular cancer and systemic sarcoidosis - a review of the literature

Sarcoidosis is a multisystem disease that most commonly involves the lungs and the lymph nodes, but with genitourinary tract involvement, can easily mimic testicular cancer with metastasis to the lungs. We describe the case of a 30-year-old African-American male who presented with complaints of a headache, skin lesions, and a scrotal mass. A computed tomography scan of the head showed lesions in the frontotemporal and pons region, causing obstructive hydrocephalus. An ultrasound of the scrotum showed an enlarged epididymis bilaterally as well as a solid hypoechoic ill-defined mass on the right side, separate from the intact testis. Given the high suspicion for testicular malignancy with brain metastasis, a right orchiectomy was completed. The pathology revealed non-caseating necrotizing granulomas that stained negative for tubercular and fungal organisms, which was consistent with sarcoidosis. Additionally, the patient's skin and central nervous system (CNS) lesions improved on steroids that had been started for cerebral edema. Given the predilection of testicular cancer for CNS metastasis, neurosarcoidosis can also be mistaken for testicular cancer metastasis to the CNS, as seen in our case. Differentiating testicular cancer from genitourinary sarcoidosis is difficult but can be clarified using a combination of clinical presentation, epidemiology, serum markers (ACE, AFP, B-HCG), biopsies from skin/lymph nodes, and sometimes imaging. It is critical to differentiate genitourinary sarcoidosis from malignancy, as a misdiagnosis can lead to unnecessary surgical interventions, which have important implications for future fertility. There can also be a coexistence of as well as an association between testicular cancer and sarcoidosis, which should be recognized by health care providers.     

Fabrication of plasmonic dye-sensitized solar cells using ion-implanted photoanodes

Plasmonic dye-sensitized solar cells containing metal nanoparticles suffer from stability issues due to their miscibility with liquid iodine-based electrolytes. To resolve the stability issue, herein, an ion implantation technique was explored to implant metal nanoparticles inside TiO₂, which protected these nanoparticles with a thin coverage of TiO₂ melt and maintained the localized surface plasmon resonance oscillations of the metal nanoparticles to efficiently enhance their light absorption and make them corrosion resistant. Herein, Au nanoparticles were implanted into the TiO₂ matrix up to the penetration depth of 22 nm, and their influence on the structural and optical properties of TiO₂ was studied. Moreover, plasmonic dye-sensitized solar cells were fabricated using N719 dye-loaded Au-implanted TiO₂ photoanodes, and their power conversion efficiency was found to be 44.7% higher than that of the unimplanted TiO₂-based dye-sensitized solar cells due to the enhanced light absorption of the dye molecules in the vicinity of the localized surface plasmon resonance of Au as well as the efficient electron charge transport at the TiO₂@Au@N719/electrolyte interface.

Ion implantation technique can resolve the stability issue of metal nanoparticles with liquid iodine-based electrolyte to improve PCE of plasmonic dye-sensitized solar cells.     

Pancreatic Cysts: A Systematic Approach and Second Look

Background

Pancreatic cysts are relatively rare, but constitute an important disease entity that poses a challenge with clinical, radiological, and pathological differential diagnosis.

Methods

New attention has been drawn to pancreatic cysts given their potential cure rates with resection. However, preoperative distinction between neoplastic and benign lesions needs further study for effective strategies in identification and management. The role and safety of cystic fluid analysis remains to be clarified in this context.

Results

The presence of mural nodules is a significant indicator for malignancy; however, size as a reliable predictor remains controversial. Specific criteria are required with particular focus on the histologic subtype of pancreatic lesions.

Conclusion

We review recent developments in the understanding and management of cystic lesions of the pancreas.     

Testicular Seminoma Metastasis to the Gastrointestinal Tract and the Necessity of Surgery

Introduction  

Germ cell tumors rarely metastasize to the gastrointestinal (GI) tract with an incidence that is less than 5%. Germ cell tumors can be divided into two groups: pure seminomas and non-seminomas. Pure seminomas are characterized by their profound response to chemoradiation. Within the group of germ cell tumors, pure seminomas are least likely to metastasize to the GI tract with an incidence of less than 1%. The most frequent mode of metastasis to the GI tract is direct extension from the retroperitoneal lymph nodes, which drain the testes. Ileal and jejunal metastasis are more common due to their retroperitoneal locations as well as the fact that the testes have retroperitoneal lymphatic drainage. Due to the concern of retroperitoneal metastasis in germ cell tumors, retroperitoneal lymph node biopsies are advocated for accurate staging and diagnosis due to the possibility of occult involvement in these sites. Thus, amongst the GI sites for metastasis, the duodenum is the most uncommon location. The most common manifestations of GI metastasis are intestinal obstructions via volvulus or intussusception and not acute gastrointestinal bleeding. We present a case of chemoresistant pure testicular seminoma with metastasis to the duodenum with a complication of a massive upper GI bleed requiring emergent surgery.