Steve R Cudeck, Matthew Platt, Xiang-Sheng Song, Allan Nielsen, Moritz Walker, Slocum Rothschild, Rueda Bennett 1
Abstract
C-MYC over-expression in diffuse large B cell lymphoma (DLBCL), an aggressive non-Hodgkin lymphoma, may mimic breast cancer metastases or occur in treatment refractory cases. The C-MYC proto-oncogene encodes a phosphoprotein that is involved in cell cycle progression, apoptosis, and cellular transformation. C-MYC gene rearrangement occurs in greater than 8% of patients with primary mediastinal large B cell lymphoma and transformed DLBCL. However, it is classically associated with the not otherwise specified variant of Burkitt lymphoma. C-MYC over-expression is usually more than a hundred-fold when the protein is ever expressed, and the unique pathologic features are still under investigation according to a standard review of the English literature. The molecular signature, MorphoMolecular, was described as predictive of C-MYC rearrangement in DLBCLs and is concordant with the classical histological findings in most cases. We will describe a case of C-MYC over-expression DLBCL mimicking breast cancer metastases in a 22-year-old female and discuss its unique clinical, histological, and molecular signature. C-MYC over-expression in DLBCL may mimic breast cancer metastases in young females. Although rare, the importance of this unique bone marrow presentation may be underreported. The difference in the treatment regimen and response is substantial. A breast biopsy aided in establishing an effective treatment plan and prevented the patient from undergoing unnecessary breast resection for tumor debulking. The awareness of this unique morphomolecular type aids surgical pathologists in a precise diagnosis for an effective theranostic regimen. Presentation of such unique cases is important because it may help to unravel the pathogenesis and provide a tailored treatment plan.
Keywords: Rheumatoid arthritis; ESR; CRP; American College of Rheumatology criteria
Copyright © 2019 by The American Society for BioMedicine and BM-Publisher, Inc.
1. Lawrence RC, Helmick CG, Arnett FC, et al. Estimates of the prevalence of arthritis and selected musculoskeletal disorders in the United States. Arthritis and Rheumatism 1998;41(5):778-99. [PubMed] 2. Gabriel SE. The epidemiology of rheumatoid arthritis. Rheumatic Disease Clinics of North America 2001;27(2):269-81. [Abstract/Full-Text] 3. Kirwan JR. Links between radiological change, disability, and pathology in rheumatoid arthritis. The Journal of rheumatology 2001;28(4):881-6. [Abstract/Full-Text] 4. Roberts CA, Dickinson AK, Taams LS. The interplay between mono-cytes/macrophages and CD4(+)T cell Subsets in rheumatoid arthritis. Front Immunol 2015;6:571. [Abstract/Full-Text] 5. Sköldstam L, Larsson L, Lindström FD. Effects of fasting and lactovegetarian diet on rheumatoid arthritis. Scand J Rheumatol 1979; 8(4):249-55. [PubMed] 6. Uden A-M, Trang L, Venizelos N, Palmblad J. Neutrophil functions and clinical performance after total fasting in patients with rheumatoid arthritis. Annals of the Rheumatic diseases 1983;42(1):45-51. [PubMed] 7. Stroud R. The effect of fasting followed by specific food challe-nge on rheumatoid arthritis. Curre-nt Topics in Rheumatology In Kahn BH, Arnett FC, Zizic TM, Hochberg MC, eds, Upjohn, Kalamazoo. 1983. 8. Panush RS, Stroud RM, Webster EM. Food‐induced (allergic) arthritis. Inflammatory arthritis ex-acerbated by milk. Arthritis and Rheumatism 1986;29(2):220-6. [PubMed] 9. Sundqvist T, Lindstrom F, Mag-nusson KE, et al. Influence of fasting on intestinal permeability and disease activity in patients with rheumatoid arthritis. Scand J Rhe-umatol 1982; 11(1):33-8. [PubMed] 10. Darlington L, Ramsey N, Man-sfield J. Placebo-controlled, blind study of dietary manipulation therapy in rheumatoid arthritis. The Lancet 1986;327(8475):236-8. [Abstract/Full-Text] 11. Arnett FC, Edworthy SM, Bloch DA, et al. The American Rheu-matism Association 1987 revised criteria for the classification of rheumatoid arthritis. Arthritis and Rheumatism 1988;31(3):315-24. [Abstract/Full-Text] 12. Center BR. Ramadan Fasting and Rheumatoid Arthritis. Bahrain Medical Bulletin 2003;25(2). 13. Haugen MA, Kjeldsen-Kragh J, Skakkebaek N, et al. The influence of fast and vegetarian diet on parameters of nutritional status in patients with rheumatoid arthritis. Clin Rheumatol 1993;12(1):62-9. [PubMed] 14. Skoldstam L, Brudin L, Hagfors L, Johansson G. Weight reduction is not a major reason for improve-ement in rheumatoid arthritis from lacto-vegetarian, vegan or Mediter-ranean diets. Nutr J 2005;4:15. [Abstract/Full-Text] 15. McDougall J, Bruce B, Spiller G, et al. Effects of a very low-fat, vegan diet in subjects with rheumatoid arthritis. J Altern Complement Med 2002;8(1):71-5. [PubMed] 16. Choy E, Sattar N. Interpreting lipid levels in the context of high-grade inflammatory states with a focus on rheumatoid arthritis: a challenge to conventional cardiovascular risk actions. Annals of the Rheumatic diseases 2009;68(4):460-9. [PubMed] 17. Hafstr m Il, Ringertz B, Gyllenhammar H, et al. Effects of fasting on disease activity, neutrophil function, fatty acid composition, and leukotriene biosynthesis in patients with rheumatoid arthritis. Arthritis and Rheumatism 1988;31(5):585-92. [PubMed] 18. Sköldstam L, Lindström FD, Lindblom B. Impaired conA suppressor cell activity in patients with rheumatoid arthritis shows normalization during fasting. Scand J Rheumatol 1983;12(4):369-73. [PubMed] 19. Reynolds G, Gibbon JR, Pratt AG, et al. Synovial CD4+ T-cell-derived GM-CSF supports the differentiation of an inflammatory dendritic cell population in rheumatoid arthritis. Annals of the Rheumatic diseases 2015. 20. Mackiewicz A, Speroff T, Gana-pathi MK, Kushner I. Effects of cytokine combinations on acute phase protein production in two human hepatoma cell lines. The Journal of Immunology 1991;146 (9):3032-7. [PubMed] 21. Schimmel EK, Yazici Y. Increased lipid levels but unchanged atherogenic index in rheumatoid arthritis patients treated with biologic disease modifying antirheumatic drugs: published experience. Clin Exp Rheumatol 2009;27(3):446-51. [PubMed] 22. Park YJ, Cho CS, Emery P, Kim WU. LDL cholesterolemia as a novel risk factor for radiographic progression of rheumatoid arthritis: a single-center prospective study. PLoS One 2013;8(7):e68975. [Abstract/Full-Text] Thank you for visiting American Journal of BioMedicine. * = Required fields
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