Small intestine leiomyosarcoma mimicking gastrointestinal stromal tumour

2021 ◽  
Vol 14 (9) ◽  
pp. e244381
Author(s):  
Mohammed Fawaz ◽  
Kamal Kataria ◽  
Ankita Singh ◽  
Saugata Samadder
Keyword(s):  
Small Bowel ◽  
Abdominal Mass ◽  
Gastrointestinal Stromal Tumour ◽  
Standard Of Care ◽  
Malignant Tumours ◽  
Bowel Ischaemia ◽  
Vein Thrombosis ◽  
Perforation Peritonitis ◽  
Gi Bleed ◽  
Deep Vein

Small bowel malignant tumours make only 2% of all gastrointestinal (GI) malignancies. Small bowel leiomyosarcoma (LMS) is further rare, accounts for only 0.1%–3% fraction of these tumours. These cases can present as asymptomatic intra-abdominal mass, anaemia due to GI bleed or acute abdomen such as perforation peritonitis, intussusception and bowel ischaemia. Standard of care is surgical resection. Our case presented as large lobulated exophytic ileal LMS measuring 10.8×11×14.7 cm involving multiple small bowel loops and abutting right iliac vessels and uterus. Patient’s clinical course was complicated with COVID-19 positivity, deep vein thrombosis and pulmonary thromboembolism. She was managed by preoperative anticoagulation followed by resection of the tumour with end ileostomy.

scholarly journals Economic Analysis of Rivaroxaban for the Treatment and Long-Term Prevention of Venous Thromboembolism in Portugal

2014 ◽  
Vol 27 (5) ◽  
pp. 615 ◽  
Author(s):  
Isabel Fonseca Santos ◽  
Sónia Pereira ◽  
Euan McLeod ◽  
Anne-Laure Guillermin ◽  
Ismini Chatzitheofilou
Keyword(s):  
Pulmonary Embolism ◽  
Venous Thromboembolism ◽  
Standard Of Care ◽  
Quality Adjusted Life Years ◽  
Vein Thrombosis ◽  
Scenario Analyses ◽  
Life Years ◽  
Deep Vein ◽  
Quality Adjusted Life

<p><strong>Introduction:</strong> Venous thromboembolism is a burden on healthcare systems. The aim of this analysis was to project the long-term costs and outcomes for rivaroxaban compared to standard of care (enoxaparin/warfarin) in Portugal for the treatment and secondary prevention of venous thromboembolism.<br /><strong>Material and Methods:</strong> A Markov model was developed using event rates extracted from the EINSTEIN trials supplemented with literature-based estimates of longer-term outcomes. Core outcomes included per patient costs and quality-adjusted life years reported separately per treatment arm and incrementally, as well as cost per quality-adjusted life years gained. The deep vein thrombosis and pulmonary embolism indications were analysed separately. The analyses were conducted from the Portuguese societal perspective and over a 5-year time horizon. Costs and outcomes were discounted at a 5% annual rate. Several scenario analyses were undertaken to explore the impact on results of varying key modeling assumptions.<br /><strong>Results:</strong> Rivaroxaban treatment was associated with cost-savings for the treatment of deep vein thrombosis and was both cost-saving and more effective for the treatment of pulmonary embolism, compared with enoxaparin/warfarin.<br /><strong>Discussion:</strong> The results of the sensitivity and scenario analyses further supported that rivaroxaban is a cost-effective alternative to standard of care treatment. The use of an expert panel to derive some input values and the lack of Portuguese specific utilities were the main limitations.<br /><strong>Conclusion:</strong> Rivaroxaban represents an efficient alternative to using enoxaparin/warfarin in Portugal, as it’s associated with lower costs (for both indications) and greater quality adjusted life years (for the pulmonary embolism indication).</p><p><br /><strong>Keywords: </strong>Venous Thrombosis; Pulmonary Embolism; Rivaroxaban; Venous Thromboembolism.</p>

scholarly journals Thrombocytopenia and Deep Vein Thrombosis on the Top of an Iceberg

2021 ◽  
Author(s):  
Morteza Daraei ◽  
Sahar Karimpour Reyhan ◽  
Mahsa Abbaszadeh ◽  
Ali Afshari
Keyword(s):  
Deep Vein Thrombosis ◽  
Abdominal Mass ◽  
Autoimmune Disorder ◽  
Vein Thrombosis ◽  
Examination Result ◽  
Child Bearing ◽  
Initial Symptoms ◽  
Benign Leiomyoma ◽  
High Index Of Suspicion ◽  
Deep Vein

Systemic Lupus Erythematous (SLE) is a chronic autoimmune disorder with a relapsingremitting course. Besides, SLE most commonly occurs in child-bearing-age women. Due to protean manifestations, the diagnosis may be challenging; however, a high index of suspicion, i.e. achieved by experience and perceptivity is the key to a correct decision. Here, we present an SLE patient; her initial symptoms resembled a malignant process, but important elements guided us to the underlying autoimmune process. A 34-year-old woman presented with a uterine mass, deep vein thrombosis, and significant thrombocytopenia. Our first impression was malignant processes; however, considering her age with thrombosis and thrombocytopenia as the key components of her presentation, we suspected antiphospholipid syndrome and SLE. Her abdominal mass was a benign leiomyoma. We treated her with glucocorticoids and anticoagulants. Accordingly, after improving cytopenia, we discharged her and the follow-up examination result was satisfactory.

Thrombosis of the caudal vena cava presenting as an unusual cause of an abdominal mass and thrombocytopenia in a dog

2000 ◽  
Vol 36 (2) ◽  
pp. 143-151 ◽  
Author(s):  
SN LeGrange ◽  
TW Fossum ◽  
T Lemire ◽  
RW Storts ◽  
JS Thomas
Keyword(s):  
Collateral Circulation ◽  
Abdominal Mass ◽  
Vena Cava ◽  
Endothelial Damage ◽  
Neoplastic Cells ◽  
Vein Thrombosis ◽  
Neural Crest Origin ◽  
Deep Vein ◽  
Palpable Abdominal Mass ◽  
Persistent Thrombocytopenia

Thrombosis of the caudal vena cava in a dog secondary to metastatic neoplasia is described. The dog had a palpable abdominal mass and persistent thrombocytopenia due to a thrombosed caudal vena cava that was surgically removed. A few days after its removal, the dog died and neoplastic cells of neural crest origin were identified at the edge of the thrombus. Massive thrombosis can be an unusual cause of platelet consumption, leading to thrombocytopenia and disseminated intravascular coagulation. Deep vein thrombosis of the vena cava can occur in dogs and may mimic an abdominal mass. Multiple mechanisms may be involved in the development of venous thrombosis, including endothelial damage by neoplastic cells and the presence of a hypercoagulable state secondary to neoplasia. Extensive collateral circulation may allow removal of diseased vena cava.

scholarly journals Apixaban-induced haematoma causing small bowel intussusception

2019 ◽  
Vol 12 (10) ◽  
pp. e230952 ◽  
Author(s):  
Ariel P Santos ◽  
Jennifer M Rodriguez ◽  
Grace Berry
Keyword(s):  
Atrial Fibrillation ◽  
Small Bowel ◽  
Histopathological Examination ◽  
Exploratory Laparotomy ◽  
Adult Intussusception ◽  
Radiographic Findings ◽  
Vein Thrombosis ◽  
Small Bowel Intussusception ◽  
Direct Acting ◽  
Deep Vein

Apixaban (Eliquis) is a direct acting oral anticoagulant (DOAC) indicated for treatment of deep vein thrombosis, non-valvular atrial fibrillation, pulmonary embolism and postoperative venous thromboprophylaxis following hip or knee replacement. Complications are minimal and include, but are not limited to, bleeding and intracranial haemorrhage, and haematoma formation. Our patient is a 73-year-old woman who presented with clinical and radiographic findings of small bowel obstruction. She was found to be taking apixaban for atrial fibrillation. CT scan showed small bowel intussusception. She underwent an exploratory laparotomy and resection of the small bowel intussusception with primary side-to-side anastomosis. Histopathological examination showed that the intussusception was caused by an intramural haematoma. This case presents a rare instance of adult intussusception caused by a DOAC. To our knowledge, no case of intussusception caused by apixaban has yet been found in literature.

Antithrombin alfa in hereditary antithrombin deficient patients: A phase 3 study of prophylactic intravenous administration in high risk situations

2008 ◽  
Vol 99 (03) ◽  
pp. 616-622 ◽  
Author(s):  
R. Tait ◽  
Don Shaffer ◽  
Francesco Baudo ◽  
Bernard Boneu ◽  
Carl Dempfle ◽  
...  
Keyword(s):  
High Risk ◽  
Intravenous Administration ◽  
Elective Surgery ◽  
Vitamin K Antagonists ◽  
Standard Of Care ◽  
Vein Thrombosis ◽  
At Deficiency ◽  
Multi Center Study ◽  
Risk For Thrombosis ◽  
Deep Vein

SummaryDuring surgery and childbirth, patients with hereditary antithrombin (AT) deficiency are at high risk for thrombosis,and heparin prophylaxis may not be sufficiently efficacious. In these patients, exogenous AT may be used in association with heparin. A recombinant human AT (generic name: antithrombin alfa) has been developed. This multi-center study assessed the efficacy and safety of prophylactic intravenous administration of antithrombin alfa to hereditaryAT deficient patients in high risk situations, including elective surgery, childbirth, or cesarean section. Antithrombin alfa was administered prior to and during the high risk period for restoration and maintenance of AT activity at 100% of normal. Heparin, low-molecular-weight heparin, and/or vitamin K antagonists were used according to standard of care. The primary efficacy endpoint was the incidence of acute deep vein thrombosis (DVT) from baseline up to day 30 post dosing as assessed by independent central review of duplex ultrasonograms and/or venograms. Safety was assessed based on adverse events (AEs) and laboratory evaluations. Five surgical and nine obstetrical hereditary AT deficiency patients received antithrombin alfa for a mean period of seven days.No clinically overt DVT occurred. Central review of ultrasonograms identified signs of acute DVT in two out of 13 evaluable patients. No antithrombin alfa-related AEs were reported. No patient developed anti-antithrombin alfa antibodies. In conclusion, this study suggests that antithrombin alfa is a safe and effective alternative to human plasma-derived AT for treating hereditary AT deficiency patients at high risk for thromboembolic events.

Upfront Carfilzomib, Lenalidomide, Dexamethasone with Transplant in Multiple Myeloma Patients, the IFM KRd final results

Blood ◽  
2021 ◽  
Author(s):  
Murielle Roussel ◽  
Valerie Lauwers-Cances ◽  
Soraya Wuilleme ◽  
Karim Belhadj ◽  
Salomon Manier ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Residual Disease ◽  
Standard Of Care ◽  
Complete Response ◽  
Primary Objective ◽  
Vein Thrombosis ◽  
Common Grade ◽  
Grade 3 ◽  
D 20 ◽  
Deep Vein

Bortezomib, lenalidomide, dexamethasone plus transplant is a standard of care for eligible Multiple Myeloma patients. As responses can deepen with time, regimens with longer and more potent induction/consolidation phases are needed. In this phase II study, patients received eight 28-day cycles of carfilzomib (K) 20/36mg/m2 (D1-2,8-9,15-16), lenalidomide (R) 25 mg (D1-21), and dexamethasone (d) 20 mg (D1-2,8-9,15-16,22-23). All patients proceeded to transplant after 4 cycles and received 1-year lenalidomide maintenance (10 mg, D1-21). The primary objective was stringent complete response (sCR) at the completion of consolidation. Overall, 48 patients were screened and 46 enrolled; 21% had adverse cytogenetics. Among 42 evaluable patients after consolidation, 26 were in sCR (61.9%), 27 in ≥CR (64.3%): 92.6% had undetectable Minimal Residual Disease by flow cytometry (≥2.5 x10-5) and 63.0% by next generation sequencing (10-6). Median time to CR was 10.6 months. By MFC and NGS, 69.0% and 66.7% patients, respectively had undetectable MRD at some point. With a median follow-up of 60.5 months, 21 patients progressed and 10 died (7 from MM). Median PFS was 56.4 months. There was no KRd related death. Four patients discontinued the program due to toxicities; 56 serious AEs were reported in 31 patients including 8 cardiovascular events (2 heart failures, 5 pulmonary embolisms or deep vein thrombosis). Common grade 3/4 AEs were hematological (74%) and infectious (22%). In conclusion, 8 cycles of KRd produce fast and deep responses in transplant eligible NDMM patients. Safety profile is acceptable but cardiovascular AEs should be closely monitored.

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