Evaluation of glycopeptide prescription in high-risk febrile neutropenia: A monocentric study of North Africa

INTRODUCTION

High-risk febrile neutropenia (FN) is one of the main causes of morbidity and mortality in onco-hematology. The initiation of empirical antibiotic therapy is an emergency that can change the prognosis of some patients. Given the emergence of increasingly resistant Gram-positive bacteremia, glycopeptides, as an empirical treatment, have an important place in the management of high-risk FN. The aim of this study is to evaluate the appropriateness of glycopeptide prescription in high-risk FN patients.

METHODS

This study was conducted in the Hematology Department of Fattouma Bourguiba University Hospital of Monastir, Tunisia. Patients with high-risk FN were enrolled during the period between January 1 and December 31, 2020.

RESULTS

Of the 29 patients included in this study, 88 FN episodes were noted of which 39 episodes treated with glycopeptides were evaluated. Twenty-four febrile episodes were empirically treated with glycopeptides (27.3%) of which 17 prescriptions (70.8%) were appropriate according to the European Conference on Infection in Leukemia and the Infectious Diseases Society of America recommendations. A therapeutic escalation using glycopeptides was noted in 17% of cases and appropriately opted in 6 FN episodes (40%).

CONCLUSION

Prescriptions of glycopeptides were appropriate according to the international recommendations in 71% of the empirical prescriptions and in 40% of the therapeutic escalation using glycopeptides. In high-risk FN episodes, glycopeptides prescriptions should be rationalized and limited to the indications detailed in the international guidelines to control the emergence of multidrug-resistant bacteria.

Chronic-phase chronic myeloid leukemia: Incidence of BCR/ABL transcript and its correlation with presenting features, response to treatment, and survival

Introduction

Chronic myeloid leukemia (CML) is characterized by Philadelphia chromosome resulting in the fusion between the BCR gene, located on chromosome 22, and the ABL gene on chromosome 9. The prognostic significance of BCR-ABL transcript variants in CML is controversial. The aim of the current study was to evaluate the clinico-hematological presentation and evolution of the disease, response to treatment and survival according to transcript type in chronic phase CML patients.

Results

The median age of our population was 50 years with a slight female predominance (sex-ratio 0.78). Sixty percent had the b3a2 transcript and 34% had the b2a2 type. Patients with the co-expression of these two transcripts (4.5%) and those with e19a2 were excluded from the analysis. Patients with b3a2 subtype were associated significantly with thrombocytosis (p = 0.006) and higher Sokal score (p = 0.038) compared to those with b2a2 transcript. The two isolated transcripts were not significantly associated with gender, age group, blast cell percentage or the identified ranges of spleen size. Complete cytogenetic response at 12 months for b3a2 patients and b2a2 patients was 78.6% and 21.4% respectively. This difference was statistically significant (p = 0.001, HR = 9.5, 95% CI 6.5-13.7). Patients with b3a2 transcript had a higher rate of optimal molecular response at 3 months (p = 0.04, HR = 4.2, 95% CI 1-17.3) and major molecular response at 12 months (p = 0.004, HR = 4.9, 95%CI 1.5-15.1). At the date of last follow-up, most patients achieving deep molecular response (MR4 or deeper) belonged to b3a2 group (79%) (p = 0.003, HR = 5.2, 95% CI 1.6-16.4). We did not find a significant difference in OS and EFS between the two groups.

Conclusion

Our study concluded that b2a2 transcript is a prognostic factor in cytogenetic and molecular response but further studies are needed to complete this aspect.

Intraosseous hibernoma: a case report and review of the literature

Intraosseous hibernoma is a rare benign bone tumor, with only 4 cases reported in English literature.

CASE REPORT

In this report, we describe a 42-year-old man with  no past medical history and right chest pain. Imaging studies showed an osteolytic lesion with fat attenuation lesion in the right fourth rib. The lesion was completely resected and microscopic study showed mildly thickened bone trabeculae and multivacuolated brown fat cells replacing the normal white fat and hematopoietic elements. The diagnostic of intraosseous hibernoma was made.

CONCLUSION

Although it is rare, hibernoma should be included in the differential diagnosis of lipomatous  tumors.

Intraosseous hibernoma: a case report and review of the literature

Intraosseous hibernoma is a rare benign bone tumor, with only 4 cases reported in English literature.

CASE REPORT

In this report, we describe a 42-year-old man with  no past medical history and right chest pain. Imaging studies showed an osteolytic lesion with fat attenuation lesion in the right fourth rib. The lesion was completely resected and microscopic study showed mildly thickened bone trabeculae and multivacuolated brown fat cells replacing the normal white fat and hematopoietic elements. The diagnostic of intraosseous hibernoma was made.

CONCLUSION

Although it is rare, hibernoma should be included in the differential diagnosis of lipomatous  tumors.

Human papillomavirus detection using in situ hybridization and correlations with histological and cytological findings

BACKGROUND AND OBJECTIVE

The human papillomavirus (HPV) is the main causative agent of cancerous and precancerous lesions in cervical cancers. The infection detection is performed by cytological and histological examination. However, molecular testing for HPV infection remains necessary to distinguish nonspecific inflammatory lesions from HPV-related lesions. We aimed to compare cytological and histological diagnosis of HPV lesions and to confront histological findings with molecular detection of HPV by in situ hybridization (ISH).

MATERIAL AND METHODS

A total of 2399 pap smears were collected between 1997 and 2002. Twenty-nine of them presented with lesions indicative of HPV infection. Colposcopy and biopsy were performed on 23 of these 29 pap smears, with a comparison of the cytological and histological findings. Molecular testing for HPV by ISH was performed on 11 pap smears.

RESULTS

A 79% cytological and histological agreement was observed. ISH revealed the presence of the virus in seven case patients, amounting to a 63% histological and molecular agreement. Seven HPV genotypes were categorized (6-11-16-18-31-33-51).

CONCLUSION

HPV detection by ISH adds little to the diagnosis of HPV-associated lesions based on cytological and histological features. It, however, helps improve the specificity of the diagnosis and determine the viral genotype which, in turn, helps better define the lesion prognosis.

Carcinome épithélial–myoépithélial de la cavité nasale

OBJECTIVES

Epithelial-myoepithelial carcinoma is a rare tumor of the salivary glands with an incidence of less than 1%. Most cases arise in the parotid gland. Extraoral location is exceptional. The purpose of this study was to describe a case with nasal location, which is exceptionally reported in the literature.

MATERIALS AND METHODS

We report a case of epithelial-myoepithelial carcinoma arising in the nasal cavity of a 54-year-old woman.

RESULTS

The woman presented with right recurrent epistaxis and on nasal endoscopic examination was found to have a polypoid tumor in the right nasal cavity. The CT-scan demonstrated a soft tissue mass without extension to the rhinopharynx or bony destruction. Histopathologic examination revealed the tumor to consist of a mixture of a solid, tubular, and trabecular structures with a double-layered arrangement of inner eosinophilic cells and outer clear cells. Dual differentiation toward myoepithelial and epithelial cells was confirmed immunohistochemically.

CONCLUSION

The occurrence of epithelial-myoepithelial carcinoma in the nasal cavity is possible. In published cases, no recurrence or metastasis has been reported in this location.

Schwannome intracérébral: étude anatomoclinique d'une observation

BACKGROUND AND PURPOSE

We report a well-documented case of intracerebral schwannoma, presenting as a cystic and solid parietal mass, arising in a 20-year-old woman. Possible mechanisms underlying the histogenesis of this rare lesion are discussed.

METHODS

The clinical, radiological and pathological features are described. The relevant literature is reviewed.

RESULTS

The patient presented seizures and elevated intracranial pressure. Neuroradiologic findings showed a right parietal lesion with cystic and tissular components, intensely enhanced after injecting intravenous gadolinium. The tumor was removed through a right parietal craniotomy. Histological and immunochemical features confirmed the diagnostic of intracerebral schwannoma. The patient is alive without progressive local disease or metastasis. The origin of intracerebral schwannomas has been the source of much controversy. The most popular hypothesis argues that these tumors arise from the proliferation of Schwann cells in the perivascular nerve plexii.

CONCLUSIONS

Intracerebral schwannoma is an extremely rare benign tumor. About fifty cases have been reported. The importance of recognizing this tumor is stressed, particularly in younger patients, given its benign nature, radiological resemblance to other tumors and favorable response to resection without toxic treatment.

[Sclerosing hemangioma of the lung: a rare lesion with a difficult diagnosis]

Sclerosing hemangioma of the lung is a rare lesion described for the first time in 1956 by Liebow. We report a case in a 45 year-old woman who was admitted for exploration of chronic cough. The chest x-ray revealed a round opacity, well delimited in the left pulmonary parenchyma. Surgical resection enabled the histopathological diagnosis of sclerosing hemangioma. We review progress in our knowledge of the histogenesis and diagnosis of this tumor. Immunohistochemistry has been highly contributory although numerous points remain controversial.