Gogo-Ogute E. Ibodeng

Traumatic injuries to the hand are commonly encountered in the adult population. Arterial occlusion from digital emboli due to thrombosis is a less frequently observed etiology. An example is hypothenar hammer syndrome, which usually arises following a mechanical injury. we report a case of hypothenar hammer syndrome in a 41-year-old Caucasian female following a blunt injury from exercise. She presented to our facility with complaints of intermittent severe pain in her left hand with discoloration of her fourth and fifth digits. Her symptoms began following an intense upper body strength exercise session and recurred intermittently over the following four to six weeks. MRI of the left hand showed no bony fractures or soft tissue injury. She was commenced on aspirin and Xarelto and subsequently had an arteriogram revealing thrombosis in the distal left ulnar artery. She ultimately had surgical resection of the thrombosed artery with repair using a venous graft which led to the resolution of her symptoms. Xarelto was discontinued after surgery, but she remains on Aspirin.

Acute myeloid leukemia (AML) and myelodysplastic syndrome (MDS) are genetically complex and diverse diseases. Such complexity makes challenging the monitoring of response to treatment. Measurable residual disease (MRD) assessment is a powerful tool for monitoring response and guiding therapeutic interventions. This is accomplished through targeted next-generation sequencing (NGS), as well as polymerase chain reaction and multiparameter flow cytometry, to detect genomic aberrations at a previously challenging leukemic cell concentration. A major shortcoming of NGS techniques is the inability to discriminate nonleukemic clonal hematopoiesis. In addition, risk assessment and prognostication become more complicated after hematopoietic stem-cell transplantation (HSCT) due to genotypic drift. To address this, newer sequencing techniques have been developed, leading to more prospective and randomized clinical trials aiming to demonstrate the prognostic utility of single-cell next-generation sequencing in predicting patient outcomes following HSCT. This review discusses the use of single-cell DNA genomics in MRD assessment for AML/MDS, with an emphasis on the HSCT time period, including the challenges with current technologies. We also touch on the potential benefits of single-cell RNA sequencing and analysis of accessible chromatin, which generate high-dimensional data at the cellular resolution for investigational purposes, but not currently used in the clinical setting.

Review Article A snapshot of lung cancer: where are we now?—a narrative review Gogo-ogute Ibodeng, Ifeanyi Nnamdi Uche, Ruth Mokua, Michael Galo, Brendan Odigwe, Jose N. Galeas, Santanu Dasgupta

Introduction: Multiple myeloma and plasmacytoma are both plasma cell malignancies that belong to the family of blood dyscrasias. They are thought to be different entities but can occur simultaneously in some patients. Case Report: We present a unique case of a large plasmacytoma heralding the diagnosis of multiple myeloma with a preceding history of trauma which makes this case peculiar as this is an important addition to the limited existing scientific literature. The index patient was largely asymptomatic despite having a massive frontal skull/lobe lesion measuring approximately 8 × 6 cm in size alongside a chest wall mass involving the anterior left 6th rib, and a mildly displaced acute pathological fracture of the left clavicle. A primary diagnosis of multiple myeloma was made following serum protein electrophoresis with pathological confirmation of frontal skull plasmacytoma. After multidisciplinary discussion, radiotherapy was administered for plasmacytoma with complete resolution of the frontal skull mass without the need for resection and chemotherapy for multiple myeloma with daratumumab in combination with lenalidomide-dexamethasone—chosen due to anticipated poor outcome at the time of diagnosis. Autologous stem cell transplantation was subsequently instituted for multiple myeloma with a good outcome to date. Conclusion: Solitary plasmacytoma can co-exist with multiple myeloma and the prognosis remains poor in such circumstance. Patients should be followed up closely with yearly imaging—magnetic resonance imaging (MRI)/computed tomography (CT), and positron emission tomography (PET) scans. A pivotal lesson from this case report emphasizes the atypical presentation of plasmacytoma and multiple myeloma with the peculiarity of a prior history of trauma which is believed to be associated with plasma dyscrasias. Over the last decade, novel therapeutic agents such as chimeric antigen receptor T-cell therapy, which is the first approved cell-based therapy for multiple myeloma, antibody-drug conjugates, and a dozen of bi-specific antibodies/immunotherapy have been developed and shows promising outcome in the future, especially for refractory cases of multiple myeloma.