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      Synchronous Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma and Metastatic Squamous Cell Carcinoma of the Cervix Involving the Coronary Arteries Leading to Acute Myocardial Infarction

      case-report
      , ,
      Case Reports in Oncological Medicine
      Hindawi

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          Abstract

          A 66-year-old woman presented to the hospital with a one-month history of shortness of breath, fatigue, and postmenopausal vaginal bleeding and a one-week history of chest pain. This case report discusses the rare synchronous occurrence of two different malignancies in the setting of non-ST segment elevation myocardial infarction and the relation between these unfortunate events. Besides the case presented in this report, there have been only 13 reported cases of synchronous chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) associated with metastatic squamous cell carcinoma. While it is well known that malignancy causes a hypercoagulable state, there are other mechanisms which may have contributed to the patient's myocardial ischemia including external vascular compression, tumor lysis syndrome, and anemia. This case report discusses the rarity of synchronous malignancies but the importance of understanding and consideration of cardiac events in this population.

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          Most cited references11

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          Should cerebral ischemic events in cancer patients be considered a manifestation of hypercoagulability?

          Previous studies, mainly autopsy-based, suggest that the spectrum of stroke in cancer patients differs from that of the general population. These studies also suggest that cerebrovascular events frequently are a manifestation of hypercoagulability. However, no studies that address this question in the adult oncological population from a clinical perspective are available. We therefore assessed the clinical impact of cerebral ischemic events in cancer patients and attempted to determine whether their occurrence represents a manifestation of Trousseau's syndrome. A computerized database that records all neurological admissions and consultations at a tertiary medical center was used to retrospectively identify all patients with cerebral ischemic events and cancer. Thirty-three patients representing 3.5% of all stroke consultations and admissions seen at the University of Massachusetts Medical Center were identified during the period 1988 through 1992. Large-vessel atherosclerosis was the most frequent cause of stroke. Furthermore, although 30% were determined to have hypercoagulability as a cause using clinical criteria, in only one of nine patients in whom tests were done was sufficient evidence present to make a presumptive diagnosis of disseminated intravascular coagulation. Irrespective of therapy, recurrent cerebral ischemic events were noted in only 6% of patients during a follow-up period averaging greater than 9 months, a figure that is similar to that for the risk of repeated events in the noncancer population. Recognizing the limitations of this retrospective study, it appears nonetheless that conventional stroke origins account for the majority of cerebral ischemic events in the adult cancer population. Although hypercoagulability is present to a greater extent than in the nononcological population, recurrent strokes seem to occur no more frequently than in the nononcological population, and antiplatelet agents seem sufficient therapy for most patients.
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            Arterial Ischemic Events Are a Major Complication in Cancer Patients with Venous Thromboembolism

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              Rasburicase (Elitek): a novel agent for tumor lysis syndrome.

              Sis Ueng (2005)
              The overall incidence of tumor lysis syndrome in adults is not well defined, and its occurrence can be unpredictable. Several strategies are available for the prevention and treatment of tumor lysis syndrome, with rasburicase being the most recent. Rasburicase is a recombinant urate oxidase enzyme approved for use by the Food and Drug Administration in patients who are at risk of developing tumor lysis syndrome or for the management of elevated uric acid levels. Clinical trials have demonstrated rasburicase to be effective in both the pediatric and adult populations, although the drug is currently indicated only for use in the pediatric population. Adverse effects associated with rasburicase can be significant, ranging from anaphylactic reactions to methemoglobinemia. To ensure accuracy of uric acid test results, special laboratory handling procedures must be followed while patients receive rasburicase. Compared with allopurinol and intravenous sodium bicarbonate, rasburicase is costly, and therefore judicious use of the medication is warranted.
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                Author and article information

                Contributors
                Journal
                Case Rep Oncol Med
                Case Rep Oncol Med
                CRIONM
                Case Reports in Oncological Medicine
                Hindawi
                2090-6706
                2090-6714
                2020
                21 February 2020
                : 2020
                : 6192754
                Affiliations
                SUNY Upstate Medical University Hospital, 750 E Adams St., Syracuse, NY 13210, USA
                Author notes

                Academic Editor: David Lindquist

                Author information
                https://orcid.org/0000-0003-4457-8165
                Article
                10.1155/2020/6192754
                7060405
                32158573
                b44a26a9-8542-4479-86f4-7658358f1094
                Copyright © 2020 Michelle Bernshteyn et al.

                This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 19 August 2019
                : 11 February 2020
                Categories
                Case Report

                Oncology & Radiotherapy
                Oncology & Radiotherapy

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