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Article Excerpt
ONC1-A. NEUTROPENIC ENTEROCOLITIS WITH COMPLETE BOWEL NECROSIS COMPLICATING INDUCTION CHEMOTHERAPY IN A CHILD WITH ACUTE INFANTILE LEUKEMIA. Paulina Rojas, Aarati Rao, Raj P. Warner, Kenneth Ward, and Maria C. Velez. Hematology/Oncology, Department of Pediatrics, LSUHSC and Children's Hospital, New Orleans, LA.
A 4-month-old infant presented with two-week history of abdominal distention and hematochezia. Physical examination revealed pallor, marked organomegaly, ecchymosis, and petechiae. Laboratory data included WBC count of 53,000/mm3 with 87% blasts, platelet count of 12,000/mm3, Hgb of 4.1 gm/dL, and LDH of 3,327 U/dL.
Bone marrow examination confirmed the diagnosis of infantile leukemia (IALL), acute lymphocytic, L1 morphology, CALLA negative, and low DNA index. Cytogenetic analysis detected translocation (4,11) with 11q23, the MLL rearrangement. Spinal fluid was negative for blasts. Chemotherapy with decadron, vincristine, daunomycin, cyclophosphamide, asparaginase, and intrathecal was begun. The clinical course was complicated by tumor lysis syndrome requiring acute hemodialysis, profound pancytopenia, mucositis, septic shockdue to alpha-hemolytic streptococcus, and severe abdominal distention with cholestatic jaundice. Despite treatment with broad-spectrum antibiotics and antifungals, and aggressive supportive care, he subsequently developed perforation secondary to complete bowel necrosis. Because of catastrophic side effects, chemotherapy was discontinued and the child continues on TPN as his only source of intake. The child remains in hematologic and cytogenetic remission of his leukemia without further therapy after 40 months. Neutropenic enterocolitis (NE) is a life threatening inflammation of the cecum with a reported mortality rate of 50% to 100%. It is more commonly seen in hematologic malignancies. IALL carries a poor prognosis and high relapse rate with conventional chemotherapy. This child is doing well with normal development for his age after two weeks of chemotherapy for IALL with devastating side effects (complete bowel necrosis on TPN). This case exemplifies the remarkable improvements in supportive care, but at the same time highlights the need for further research in the pathophysiology of these entities with better understanding of the triggering events.
ONC2-A. PAROTID GLAND METASTASIS AS THE INITIAL MANIFESTATION OF NON-SMALL CELL LUNG CANCER. Nathan H. Fowler, MD, Derrick W. Spell, MD, and James T. Lin, MD. Division of Hematology/Oncology, Department of Internal Medicine, The University of Texas Medical Branch, Galveston, TX.
A 68-year-old man with a medical history of hypertension and heavy tobacco use presented with a six-week history of an enlarging right-sided facial mass. The patient also reported occasional right-sided facial pains, but denied any other complaints. Physical examination revealed a fixed mass in the right parotid region that measured 5 X 5 cm. MRI of the head and neck revealed a 4.7 X 3.8 X 4.3 cm mass in the superficial lobe of the right parotid gland that enhanced with gadolinium contrast. The mass extended into the facial nerve and the deep lobe of the parotid; however no other abnormalities were noted. CT of the thorax revealed a mass in the left upper lobe measuring 8 X 5 X 8 cm and enlarged subcarinal lymph nodes. Bronchial washings from the left upper lobe and a biopsy of the right parotid gland both confirmed poorly differentiated squamous cell carcinoma. The patient was initially treated with paclitaxel and carboplatin. After four cycles of chemotherapy, the patient had no measurable disease in his pa rotid gland. CT of thorax was repeated and revealed resolution of the subcarinal lymphadenopathy and a decrease...
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