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Recent Updates on Pediatric Oncological Emergencies and Their Management.

Pediatric oncological emergencies are acute, life-threatening complications arising from malignancies or their treatment. Prompt recognition and intervention are essential to prevent significant morbidity and mortality. Pediatric oncological emergencies are categorized as metabolic, structural, hematological, or treatment-related. Structural emergencies include superior mediastinal syndrome, spinal cord compression, and raised intracranial pressure. Metabolic complications such as tumor lysis syndrome (TLS) and hypercalcemia are frequent, with TLS most common in leukemias and high-grade lympho…

Progressive Macroglossia and Dysphagia as the Initial Manifestation of Systemic Amyloid Light-Chain (AL) Amyloidosis Associated With Multiple Myeloma: A Case Report and Literature Review.

Systemic amyloid light-chain (AL) amyloidosis is characterized by the extracellular deposition of misfolded immunoglobulin light chains in tissues and is often associated with plasma cell dyscrasias, including multiple myeloma. Macroglossia is an uncommon but characteristic manifestation and may rarely be the presenting feature. We report the case of a 68-year-old woman who presented with progressive tongue enlargement, dysphagia, and significant weight loss over six months. Laboratory evaluation revealed severe anemia, hypercalcemia, markedly elevated serum free kappa light chains with a prof…

Parathyroid carcinoma in a nonorthotopic supraclavicular location: a 20-year course.

Parathyroid carcinoma is a rare cause of primary hyperparathyroidism (PHPT) and is often difficult to distinguish from benign parathyroid di … tial surgery resulted in biochemical remission following removal of a parathyroid adenoma; however, hypercalcemia and elevated intact parathyroid hormone levels recurred over time. Subsequent resections demonstrated parathyroid-type proliferation with increasing Ki-67 index, and the final surgery revealed capsular and venous invasion consistent with carcinoma. …

Multiple Myeloma: Diagnosis and Treatment.

Multiple myeloma, a hematologic malignancy of plasma cells characterized by excessive monoclonal protein production, accounts for 36,000 new cancer diagnoses annually in the United States. The median age at diagnosis is 69 years. Multiple myeloma may present with symptoms, such as bone pain, fatigue, anemia, weight loss, kidney failure, and hypercalcemia, although some patients are asymptomatic. Initial evaluation includes complete blood cell count, comprehensive metabolic panel, serum calcium level, urinalysis, thyroid-stimulating hormone (thyrotropin), urine and serum protein electrophoresis…

Video-Assisted Thoracoscopic Resection of an Upper Mediastinal Ectopic Parathyroid Adenoma.

Primary hyperparathyroidism (pHPT) is typically caused by a parathyroid adenoma, although some cases arise from ectopic glands. Accurate preoperative localization is essential for guiding surgical strategy, particularly for mediastinal lesions. We report successful video-assisted thoracoscopic surgery (VATS) for an upper mediastinal parathyroid adenoma. A 68-year-old woman was referred for hypercalcemia during evaluation for recurrent ureteral stones. Laboratory tests revealed elevated serum calcium (13.2 mg/dl) and intact parathyroid hormone (iPTH) levels (266 pg/ml). Contrast-enhanced comput…

Регулирование причиняемой раком боли в хосписе и паллиативном уходе.

Раковая боль в костях (CIBP) one - наиболее распространенные симптомы инвалидности, встречающиеся в хосписе и паллиативном уходе. Метастазы костей особенно часто встречаются у пациентов с множественной миеломой, раком груди и раком простаты, и они могут вызывать непрерывную фоновую боль, боль, связанную с движением, патологический перелом, злокачественное сжатие спинного мозга и гиперкальцемию злокачественности. CIBP является результатом сложного взаимодействия ноцицептивных, подстрекательских и нейропатических механизмов, обусловленных взаимодействием опухолей со стромой и центральной сенсиби

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Cancer-induced bone pain (CIBP) is one of the most prevalent and disabling symptoms encountered in hospice and palliative care. Bone metasta … in, movement-related breakthrough pain, pathologic fracture, malignant spinal cord compression, and hypercalcemia of malignancy. CIBP results from a complex interplay of nociceptive, inflammatory, and neuropathic mechanisms driven by tumor-stroma interactions and central sensitization. Effective management requires careful differentiation between continuous bac …

Case Report: Tattoo sarcoidosis with epithelioid cell granuloma positive for Propionibacterium acnes.

INTRODUCTION: Tattoo sarcoidosis is characterized by a granulomatous reaction localized to the tattoo site and typical systemic symptoms of sarcoidosis. Herein, we report the case of a patient diagnosed with tattoo sarcoidosis. CASE REPORT: A 28-year-old man presented with subcutaneous nodules at two tattoo sites, bilateral hilar and mediastinal lymphadenopathy, multiple micronodules predominantly in the upper lobes of both lungs, elevated serum angiotensin-converting enzyme and soluble interleukin-2 receptor levels, hypercalcemia, and renal dysfunction. Skin biopsy of a subcutaneous nodule r…

Neonatal severe hyperparathyroidism with inactivating calcium sensing receptor (CaSR) mutation (p.I81K).

OBJECTIVES: Neonatal severe hyperparathyroidism (NSHPT) is a rare condition characterized by inactivating mutations in the calcium-sensing receptor (CaSR) gene, leading to significant hypercalcemia and related complications. CASE PRESENTATION: We present a case of a six-day-old male infant with weakness, jaundice, and hypotonia, later diagnosed with NSHPT due to a known homozygous CaSR mutation (c.242T>A; p.I81K). Initial laboratory findings revealed markedly elevated serum calcium levels and high parathyroid hormone levels which were compatible with primary hyperparathyroidism. After initial…

Successful management of hypercalcemic crisis by continuous renal replacement therapy with regional citrate anticoagulation and surgery: a case report.

A hypercalcemic crisis (HC) is a life-threatening endocrine emergency if not promptly diagnosed and treated. Initial management for HC inclu … alcemic crises. Further research is required to investigate the role of CRRT with RCA in refractory hypercalcemia.

Case Report: Application of combined transplantation of multiple autologous flaps in preventing empty pelvis syndrome after radical surgery for isolated sacrococcygeal recurrence of anal canal squamous.

Anal canal carcinoma is a rare malignancy, accounting for less than 3% of gastrointestinal tumors. Recurrent anal canal carcinoma, which occurs in less than 1% of cases, is often accompanied by severe complications. Surgery plays a crucial role in improving patients' quality of life and controlling systemic paraneoplastic syndromes. This article reports a case of a 52-year-old female patient with recurrent anal canal squamous cell carcinoma (pT4bN0M0, Stage IIIB) 7 months after comprehensive treatment, complicated by rectovaginal fistula (RVF) and hypercalcemia of malignancy (HCM). Following m…

A giant parathyroid adenoma that was successfully managed by lobectomy and en bloc resection: a case report.

BACKGROUND: Giant parathyroid adenoma is a rare presentation of parathyroid adenoma and can manifest only with neck mass or non-specific symptoms. CASE PRESENTATION: In this report, a 43-year-old woman was referred to our clinic with polyuria two months ago and a neck mass with newly diagnosed stage hypertension. No additional clinical presentations were found. The laboratory study revealed hyperparathyroidism (Parathyroid hormone (PTH): 1124 pg/ml) and hypercalcemia (15.8 mg/dl). DISCUSSION: Color Doppler sonography showed a 32 × 15 × 20 mm3 well-defined hypoechoic solid mass in the region …

Interplay between endocrine disorders and liver dysfunction: Mechanisms of damage and therapeutic approaches.

Endocrine disorders frequently lead to metabolic disturbances that significantly affect liver function. Understanding the complex interplay … regulation, often resulting in hepatic steatosis or cholestasis. Hyperparathyroidism and consequent hypercalcemia have been linked to hepatic calcifications. Insulin resistance, both hepatic and peripheral, contributes to excessive lipid accumulation in the liver, exacerbating steatotic changes. Adrenal gland disorders, particularly in the setting of chronic li …

Serum Calcium as a Determinant of Fibroblast Growth Factor 23 Levels in Patients With Primary Hyperparathyroidism and Graves' Disease.

OBJECTIVE: Fibroblast growth factor 23 (FGF23) is a phosphate-regulating hormone with an emerging role in calcium homeostasis. However, its … hatemia in PHPT and hyperphosphatemia in Graves' disease. CONCLUSIONS: These findings suggest that hypercalcemia may directly contribute to FGF23 elevation, independent of phosphate levels. However, the compensatory effect of FGF23 in modulating calcium homeostasis appears to be limited. This study provides new insights into the calcium sensitivity of FGF23 in …

Burkholderia cepacia Splenic Abscess in a Newly Diagnosed Multiple Myeloma Patient.

INTRODUCTION: Splenic abscesses are rare and primarily affect immunocompromised patients. Burkholderia cepacia, an opportunistic, multidrug- … epacia. The patient was diagnosed with multiple myeloma based on a history of recurrent infections, hypercalcemia, anemia, A:G reversal, and bone marrow biopsy findings. He was treated with intravenous antibiotics and supportive care, leading to clinical improvement. CONCLUSION: This case highlights the importance of considering B. cepacia as a causative agent …

Pulmonary Metastatic Calcifications Secondary to Chronic Renal Failure.

Pulmonary metastatic calcification (PMC) is a rare but significant condition associated with chronic renal failure, particularly in patients undergoing long-term hemodialysis. PMC results from abnormal calcium-phosphate metabolism, leading to ectopic deposition of calcium salts in lung tissues. It can also occur due to hypercalcemia, primary and secondary hyperparathyroidism, excessive exogenous administration of calcium and vitamin D, sarcoidosis, milk-alkali syndrome, osteoporosis, renal or liver transplantation, and Paget's disease. Pathogenesis involves hyperphosphatemia, secondary hyperpa…

Palliative Care for Patients With Breast Cancer in a Palliative Care Unit of a Japanese Hospital.

Background This study describes the end-of-life care management in palliative care units (PCUs) for patients with breast cancer in Japan. Me … obstructive jaundice (6/32, 18.8%), disseminated intravascular coagulation (DIC) (4/32, 12.5%), and hypercalcemia (1/32, 3.1%). Most patients had no indications for pleural effusion removal, biliary drainage, or anticoagulation therapy. Palliative sedation was performed in 25% of the patients with breast cancer, mainly to relieve intolerable general fatigue. Th …

Subtotal Versus Total Parathyroidectomy for the Management of Tertiary Hyperparathyroidism: A Systematic Literature Review and Meta-Analysis of Optimal Surgical Modality.

Background: Surgery is the definitive treatment option for tertiary hyperparathyroidism (THPT), however, the optimal surgical approach remai … transiently higher post-operative PTH in the total PTX with auto-transplantation cohort (P = .03). Hypercalcemia cure rates were 98%-100% with no difference between surgical techniques (P = .67). Safety profiles were comparable and low.Conclusions: Total PTX with auto-transplantation and subtotal PTX yield similar efficacy and safety for THPT, with no signific …

Hyperparathyroidism and Peripheral Arterial Disease.

Primary hyperparathyroidism (PHPT) is presented in various forms, including classic PHPT, characterised by increased parathyroid hormone (PT … ascular morbidity and mortality, independent of classical risk factors for atherosclerosis. Chronic hypercalcemia associated with increased levels of PTH contributes to the development of calcification of vessel walls and atherosclerotic plaques. Vascular calcification can occur in the intima or media of the arterial wall and is associated with stiffness of per …

Single zoledronic acid infusion as a cause of acute kidney impairment requiring dialysis in two patients with osteoporosis.

Zoledronic acid is a widely used bisphosphonate for treating osteoporosis and hypercalcemia related to malignancy. It is also used to prevent bone loss induced by cancer treatment and bone metastases in various cancer types. Zoledronic acid is safe for most patients and is generally not associated with severe side effects. However, there have been reports of acute kidney impairment occurring after administration of intravenous zoledronic acid, mostly in patients with cancer (who received a high cumulative dose of this medication) or preexisting kidney impairment, and in patients with a history…

Экстренные ситуации в гематологии: Почему, когда и как я лечусь?

Гематологические чрезвычайные ситуации являются критическими медицинскими условиями, требующими неотложного внимания в силу их быстрого развития и опасного для жизни характера. В качестве примера можно привести гиперкальцемию, которая часто ассоциируется с раком, таким как множественная миелома, что может привести к серьезной неврологической и сердечной дисфункции. Гиперлейкоцитоз, распространенный в острой миэлоидной лейкемии, повышает риск лейкостаза и многоорганического отказа. Кислородный кризис, обычное осложнение серповидноклеточной болезни, является результатом вазооккуляции, приводящей

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Hematological emergencies are critical medical conditions that require immediate attention due to their rapid progression and life-threatening nature. As various examples, hypercalcemia, often associated with cancers such as multiple myeloma, can lead to severe neurological and cardiac dysfunction. Hyperleukocytosis, common in acute myeloid leukemias, increa…