The case report by Parthasarathy et al. illustrates that breast
implant-associated anaplastic large cell lymphoma (ALCL) can present as a
locally aggressive tumor mass, and that this tumor can be refractory to
chemotherapy and radiotherapy. In effect, the authors describe that the
tumor was finally felt to be controlled after radical mastectomy including
resection of the implant and its surrounding capsule.
The case report by Parthasarathy et al. illustrates that breast
implant-associated anaplastic large cell lymphoma (ALCL) can present as a
locally aggressive tumor mass, and that this tumor can be refractory to
chemotherapy and radiotherapy. In effect, the authors describe that the
tumor was finally felt to be controlled after radical mastectomy including
resection of the implant and its surrounding capsule.
The authors discuss that this tumor usually presents with an
effusion, and less frequently presents with a tumor mass like the case
that is reported. However, we believe the authors make one contradictory
and one inaccurate statement in the discussion.
First, the authors point on one hand that "The United States Food and
Drug Administration (FDA) noted a possible association between breast
implants and ALCL, and believed that women with breast implants had a
small but increased risk of developing ALCL adjacent to the implant." On
the other hand, later on the discussion, the authors appear to endorse the
opinion that "large clinical studies do not show an increased risk of
lymphoma in women with breast implant. Patients with breast implants
should not be unduly concerned about the risk of developing lymphoma, but
doctors should be wary of patients with breast implants presenting with
vague symptomatology, especially a persisting seroma or a mass lesion."
We believe these statements need to be reconciled.
Second, the authors state that "Cases associated with an effusion
within the implant capsule are typical ALK positive, while those
presenting with a solid mass, like our patient, are typically ALK
negative." The authors don't provide a reference for their statement,
that is also emphasized in the subheading of "Learning Points". In our
experience and in our review of the literature, breast implant-associated
ALCL presenting as an effusion or presenting as a mass appear to represent
different stages of the same disease, and are almost always ALK negative.
Thanks to Dr Kai Ivar M?ller and Dr Svein Ivar Bekkelund for their
very interesting case presented regarding Visual impairment and
posterior cortical atrophy preceding rapid progressive dementia. Posterior
cortical atrophy (PCA) is a neurodegenerative condition regarded as a
progressive loss of visual processing skills and other posterior
functions. Patients have difficulty integrating visual scenes, locating
objects...
Thanks to Dr Kai Ivar M?ller and Dr Svein Ivar Bekkelund for their
very interesting case presented regarding Visual impairment and
posterior cortical atrophy preceding rapid progressive dementia. Posterior
cortical atrophy (PCA) is a neurodegenerative condition regarded as a
progressive loss of visual processing skills and other posterior
functions. Patients have difficulty integrating visual scenes, locating
objects or identify them, and steer their environment.
Some of the symptoms quite often associated with parietal function
deficits symptoms such as calculating numbers, praxis and reading.
Diagnosis is often delayed in as symptoms can be difficult for the patient
to express and for the clinician to spot. Although the diagnosis is
particularly challenging in the earliest stages of the disease but in
general it depend on the clinical, features.
On direct comparison between Alzheimer's disease and PCA, there was no
difference in the distribution of amyloid, as measured by Pittsburgh
Compound B (PIB) PET (Dr. Rabinovici and his colleagues study). In
contrast, PCA patients showed more severe hypometabolism in occipital
cortex, concordant with their more severe visual dysfunction. Functional
imaging and fMRI, as well as structural imaging may help to better
understand network degeneration in AD variants.
REFERENCE:
Rosenbloom MH, Alkalay A, Rabinovici GD, et al. Distinct clinical and
metabolic deficits in PCA and AD are not related to amyloid distribution.
Neurology 2011; E-pub 2011 April 27.
Dr Os hammer MBBch.,MSC.,MRCPsych .,IAPA
I read with great interest the article concerning amplification of
ALK gene detected in a IMT of breast, largely because ALK gene
amplification was recently described in inflammatory breast cancer.
However, judging from the figure 3B illustrated, I suspect that a
rearrangement rather than amplification occur as most nuclei demonstrate
one yellow fused signal, one red signal and one green signal. ALK g...
I read with great interest the article concerning amplification of
ALK gene detected in a IMT of breast, largely because ALK gene
amplification was recently described in inflammatory breast cancer.
However, judging from the figure 3B illustrated, I suspect that a
rearrangement rather than amplification occur as most nuclei demonstrate
one yellow fused signal, one red signal and one green signal. ALK gene
translocation should be more commonly encountered in IMT in general.
I did like this case report- honestly. However, I required more
information to satisfy my curiosity of the case and had reluctance in
accepting the conclusion regarding how this case validates the possibility
that quetiapine is soley responsible for the apparent positive outcome. I
would prefer to know why in 2009 he decided he wanted to curtail his
drinking? Given that his recovery co-incided with a diagnosis of bi-polar...
I did like this case report- honestly. However, I required more
information to satisfy my curiosity of the case and had reluctance in
accepting the conclusion regarding how this case validates the possibility
that quetiapine is soley responsible for the apparent positive outcome. I
would prefer to know why in 2009 he decided he wanted to curtail his
drinking? Given that his recovery co-incided with a diagnosis of bi-polar
disorder and quetiapine whether any other interventions( counselling,
psychotherapy etc) occurred?
His persistently elevated GTT with normal Trans. No FBCor CDT, and no
mentioned liver disease diagnosis?
I put it forward that treatment of his bipolar disorder successfully-
regardless of the the 'drug-specific'is as likely , and has far more
evidence-base than the drug Que
Sir,
We read with interest the case report by Sati et al. The described
procedure of replacement of a damaged cornea appears to be promising in
other porphyria cases wiht severe eye onvolvement. We just question
whether the diagnosis of porphyria cutanea tarda (PCT) is correct taking
into consideration the severity of the symptoms in this patient.
Unfortunately, the authors did not provide quantitative data of the
porp...
Sir,
We read with interest the case report by Sati et al. The described
procedure of replacement of a damaged cornea appears to be promising in
other porphyria cases wiht severe eye onvolvement. We just question
whether the diagnosis of porphyria cutanea tarda (PCT) is correct taking
into consideration the severity of the symptoms in this patient.
Unfortunately, the authors did not provide quantitative data of the
porphyrin concentrations and the ratio of the porphyrin isomers in the
investigated body fluids, which precludes that an exact diagnosis can be
achieved. The authors mention, however, that protoporphyrin was increased
in the blood. This last statement indicates that this patient likely
suffers from one of the rare recessive forms of porphyria such as
congenital erythropoietic porphyria (CEP) or hepatoerythropoietic
porphyria (HEP). Erythrocyte protoporphyrin is not elevated in PCT, but
regularly elevated in the CEP and HEP. Both CEP and HEP are known to
cause severe eye involvement as seen in this patient.
The correct diagnosis is important, as treatment depends on it. Whereas
PCT can be treated by repeated phlebotomies to remove excess iron from the
liver or by low dose chloroquine, in the rare recessive porphyrias, only
light avoidance limits skin damage.
Wilson's disease is known to directly affect parathyroid function
resulting in hypoparathyroidism. In a patient with rickets, one would
expect secondary hypoparathyroidism. Moreover, this patient likely
suffered from vitamin D resistant rickets due to renal calcium and
phosphate wasting. Were PTH and serum vitamin D levels assayed in this
instance?
Wilson's disease is known to directly affect parathyroid function
resulting in hypoparathyroidism. In a patient with rickets, one would
expect secondary hypoparathyroidism. Moreover, this patient likely
suffered from vitamin D resistant rickets due to renal calcium and
phosphate wasting. Were PTH and serum vitamin D levels assayed in this
instance?
This is a brilliant case report for which the authors, Singh and Jan
deserved to be congratulated. It delivers the important message that
something so cavalier and benign as orgasmic or coital cephalgia may be
associated with something so sinister and potentially life threatening as
intracranial haemorrhage. First of all orgasmic cephalgia needs to be
taken seriously and secondly a prompt neuroimaging scan e.g. CT or M...
This is a brilliant case report for which the authors, Singh and Jan
deserved to be congratulated. It delivers the important message that
something so cavalier and benign as orgasmic or coital cephalgia may be
associated with something so sinister and potentially life threatening as
intracranial haemorrhage. First of all orgasmic cephalgia needs to be
taken seriously and secondly a prompt neuroimaging scan e.g. CT or MRI may
be life saving. It would be tremendously educational if the BMJ commission
a full review article on orgasmic and coital cephalgia by an expert in the
field.
Many thanks go the authors for reporting this very interesting
finding.
A minor comment, please:
Figure 1, although it is somewhat blurred and dark, the MRI sequence
it contains seems be to the "T2 FLAIR" one, not the T1 with Gadolinium, as
the manuscript reads. Therefore, the lesions it demonstrates are the non-
suppressed hyper-intensities from the T2-weighted film (which is not
shown).
Many thanks go the authors for reporting this very interesting
finding.
A minor comment, please:
Figure 1, although it is somewhat blurred and dark, the MRI sequence
it contains seems be to the "T2 FLAIR" one, not the T1 with Gadolinium, as
the manuscript reads. Therefore, the lesions it demonstrates are the non-
suppressed hyper-intensities from the T2-weighted film (which is not
shown).
The case report by Parthasarathy et al. illustrates that breast implant-associated anaplastic large cell lymphoma (ALCL) can present as a locally aggressive tumor mass, and that this tumor can be refractory to chemotherapy and radiotherapy. In effect, the authors describe that the tumor was finally felt to be controlled after radical mastectomy including resection of the implant and its surrounding capsule.
The...
Thanks to Dr Kai Ivar M?ller and Dr Svein Ivar Bekkelund for their very interesting case presented regarding Visual impairment and posterior cortical atrophy preceding rapid progressive dementia. Posterior cortical atrophy (PCA) is a neurodegenerative condition regarded as a progressive loss of visual processing skills and other posterior functions. Patients have difficulty integrating visual scenes, locating objects...
Dear Editor,
The photomicrograph in this case report is not that of a Brunner gland adenoma. It is of an adenomatous polyp of the surface epithelium.
Yours sincerely, Andrew Mitchell MD
Conflict of Interest:
None declared
Dear Sir,
I read with great interest the article concerning amplification of ALK gene detected in a IMT of breast, largely because ALK gene amplification was recently described in inflammatory breast cancer. However, judging from the figure 3B illustrated, I suspect that a rearrangement rather than amplification occur as most nuclei demonstrate one yellow fused signal, one red signal and one green signal. ALK g...
I did like this case report- honestly. However, I required more information to satisfy my curiosity of the case and had reluctance in accepting the conclusion regarding how this case validates the possibility that quetiapine is soley responsible for the apparent positive outcome. I would prefer to know why in 2009 he decided he wanted to curtail his drinking? Given that his recovery co-incided with a diagnosis of bi-polar...
Sir, We read with interest the case report by Sati et al. The described procedure of replacement of a damaged cornea appears to be promising in other porphyria cases wiht severe eye onvolvement. We just question whether the diagnosis of porphyria cutanea tarda (PCT) is correct taking into consideration the severity of the symptoms in this patient. Unfortunately, the authors did not provide quantitative data of the porp...
Sir,
Wilson's disease is known to directly affect parathyroid function resulting in hypoparathyroidism. In a patient with rickets, one would expect secondary hypoparathyroidism. Moreover, this patient likely suffered from vitamin D resistant rickets due to renal calcium and phosphate wasting. Were PTH and serum vitamin D levels assayed in this instance?
Yours sincerely,
Kushal Naha, MD
...This is a brilliant case report for which the authors, Singh and Jan deserved to be congratulated. It delivers the important message that something so cavalier and benign as orgasmic or coital cephalgia may be associated with something so sinister and potentially life threatening as intracranial haemorrhage. First of all orgasmic cephalgia needs to be taken seriously and secondly a prompt neuroimaging scan e.g. CT or M...
Many thanks go the authors for reporting this very interesting finding.
A minor comment, please:
Figure 1, although it is somewhat blurred and dark, the MRI sequence it contains seems be to the "T2 FLAIR" one, not the T1 with Gadolinium, as the manuscript reads. Therefore, the lesions it demonstrates are the non- suppressed hyper-intensities from the T2-weighted film (which is not shown).
Th...
This is my mummys case, i just hope shes gonna be okay now as shes been through alot the last 15 months xx
Conflict of Interest:
None declared
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