title: Myelodysplastic syndrome progresses rapidly into erythroleukemia associated with synchronous double cancers of the stomach and the papilla of Vater.
abstract: Patients with myelodysplastic syndrome (MDS) show a relatively high incidence of developing cancers. However, it is extremely rare that synchronous double cancers develop in an MDS patient. We report a case of MDS that progressed rapidly into erythroleukemia (M6 by French-American-British classification) complicated by gastric cancer and carcinoma of the papilla of Vater. A 66-year-old man was admitted because of pancytopenia with peripheral blasts. A diagnosis of MDS (with refractory anemia with excess of blasts in transformation [RAEB-T]) was made by bone marrow examination. Chromosome analysis revealed 46,XY. An early gastric cancer was also diagnosed by endoscopic examination. The peripheral blasts gradually proliferated and the disease progressed to M6. A chromosome abnormality 46,XY,del(1)(q42) was detected at the leukemic transformation. A CAG (low-dose cytarabine and aclarubicin in combination with granulocyte colony-stimulating factor) regimen was started as a remission-induction therapy. However, obstructive jaundice developed and a marked dilatation of bile ducts was observed by abdominal computed tomography (CT). A carcinoma of the papilla of Vater was detected by endoscopy. As remission was achieved and the pancytopenia improved, the patient subsequently underwent a surgical jejuno-choledochostomy to manage the jaundice. However, the leukemia relapsed thereafter and additional chromosome abnormalities including der(5)t(5;10)(p15:q11) were observed.
authors.affiliation: Second Department of Internal Medicine, Tenshi Hospital, Sapporo, Hokkaido, Japan. tohrut@cocoa.ocn.ne.jp
authors.forename: T
authors.initials: T
authors.lastname: Takahashi
authors.forename: Y
authors.initials: Y
authors.lastname: Kazama
authors.forename: H
authors.initials: H
authors.lastname: Shimizu
authors.forename: M
authors.initials: M
authors.lastname: Yoshimoto
authors.forename: M
authors.initials: M
authors.lastname: Tsujisaki
authors.forename: S
authors.initials: S
authors.lastname: Aoki
authors.forename: K
authors.initials: K
authors.lastname: Imai
mesh_terms: D015250:Aclarubicin / Q000008:administration & dosage; D000230:Adenocarcinoma / Q000150:complications / Q000235:genetics / Q000473:pathology / Q000601:surgery; D000368:Aged; D014670:Ampulla of Vater; D000754:Anemia, Refractory, with Excess of Blasts / Q000188:drug therapy / Q000235:genetics / Q000473:pathology; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000627:therapeutic use; D001853:Bone Marrow / Q000473:pathology; D001651:Cholestasis, Extrahepatic / Q000209:etiology; D002869:Chromosome Aberrations; D025063:Chromosome Disorders; D003138:Common Bile Duct Neoplasms / Q000150:complications / Q000235:genetics / Q000601:surgery; D003561:Cytarabine / Q000008:administration & dosage; D018450:Disease Progression; D016179:Granulocyte Colony-Stimulating Factor / Q000008:administration & dosage; D006801:Humans; D007621:Karyotyping; D004915:Leukemia, Erythroblastic, Acute / Q000188:drug therapy / Q000235:genetics / Q000473:pathology; D008297:Male; D009378:Neoplasms, Multiple Primary / Q000235:genetics; D016609:Neoplasms, Second Primary; D010198:Pancytopenia / Q000209:etiology; D013274:Stomach Neoplasms / Q000235:genetics / Q000473:pathology
chemical_list: D003561:Cytarabine; D016179:Granulocyte Colony-Stimulating Factor; D015250:Aclarubicin