polycythemia-vera-in-a-patient-with-breast-cancer

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Polycythemia Vera in a Patient with Breast Cancer Hamid GA and Abbas R Department of Oncology Faculty of Medicine National Oncology Center Aden University Yemen Corresponding author: Gamal Abdul Hamid Department of Oncology Faculty of Medicine National Oncology Center Aden University Yemen Tel: 967711323798 E- mail: drgamal2000yahoo.com Rec date: September 15 2018 Acc date: September 20 2018 Pub date: September 24 2018 Copyright: © 2018 Hamid GA et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License which permits unrestricted use distribution and reproduction in any medium provided the original author and source are credited. Background A 65 years old female non-smoker who presented with lef breast mass general weakness and hepatosplenomegaly. On examination there was facial plethora and lef breast swelling since two years ago which increased gradually in size in last month. Her blood pressure was 130/90 pulse rate 90 per minute. Cardiac examination revealed normal heart sound and no extra-sound murmurs or gallops peripheral plus were normal in all four extremities. Her chest was normal on auscultation and there were no signs of clubbing or cyanosis abdominal examination sof with palpable liver and spleen. Investigations on Admission Haemoglobin 19.8 gm/dl RBC 7.65 million HCT 60.1 MCV 78.5 L/ l MCH 25.9 L/pg MCHC 32.9 g/dl leukocytes 6.200 mm 3 neutrophils 52 monocytes 7 lymphocytes 41 platelet 498.000 mm 3 . Hepatic enzymes and LDH were normal. Creatinine was 0.7 she had never received a red blood cell transfusion. Her Chest CT scan showed ill-de ined irregular mass lesion with areas of necrosis in the le t breast measuring 27 × 23 cm and enlarged le t axillary lymph nodes 1 cm otherwise normal. Echocardiography is normal and abdominal sonography showed moderate hepatosplenomegaly with gallbladder hyper-echoic deposit measured about 6.11 mm at the posterior wall could be stone. She underwent modifed-radical mastectomy on 18/2/2016 Biopsy report: Invasive ductal carcinoma grade III with eight out of ten lymph nodes were positive for malignancy staged T1N1Mx with triple negative receptors. She started chemotherapy cyclophosphamide 800 mg Epirubicine 160 mg and 5-Fourouracil 800 mg every 3 weeks and completed 6 courses followed by radiotherapy Table 1. Gradual and dramatic normalization of complete blood count during chemotherapy and during the 30 months afer chemotherapy. FEC Chemotherapy Hemoglobin/ gm/dl Hematocrit/ WBC/ mm 3 RBC/ 10 12 /L Platelets/mm 3 Abdomen Sonogram Before chemotherapy 19.8 60.1 6200 7.65 498000 Hepatosplenomegaly After 3 courses 13.2 39.1 4100 4.68 510000 Normal After 6 courses 12.1 38.4 4300 4.6 643000 Normal After 6 months 13 38.7 6700 4.8 586000 Normal After 1 year 13.3 38.5 4100 4.9 510000 Normal After 2 years 15.2 46 11000 6 343000 Normal Table 1: Follow up before during and afer chemotherapy. Polycythemia Vera PV also known as erythrocytosis or polycythemia rubra vera is being frst recognized in 1951 by W illiam Dameshek as “myeloproliferative neoplasia MPN” 1. Te classic Philadelphia-negative MPNs as they are now referred to include primary myelofbrosis PMF polycythemia vera PV and essential thrombocythemia ET each is characterized by mutually exclusive janus kinase 2 JAK2 calreticulin CALR and myeloproliferative leukemia oncogene virus MPL mutations. JAK2 mutation is the most frequently occurring gene mutation occurring in approximately 98 of PV cases 50 to 60 of ET cases and 55 to 65 of PMF cases 2. Te mechanisms underlying disease progression and symptom development are not very well understood. PV characterized by the over production of red blood cells as a result of acquired mutations in an early blood-forming cell. Since these early blood-forming cells have the capability to form not only red cells but also white cells and platelets any combination of these cell lines may be afected. Tis condition develops slowly and may remain undetected for many years. Polycythemia vera afects slightly more men than women. Te disorder is estimated to afect approximately 2 people per 100000 in the general population. It occurs most ofen in individuals more than 60 year old but can afect individuals under 20. Typical symptoms include fatigue pruritus loss of appetite night sweats splenomegaly abdominal pain bone pain weight loss microvascular complications and anemia 3. In MPN and especially polycythemia vera which is severely understudied and there is no literature exploring pharmacological approaches of FEC chemotherapy Epirubicin Cyclophosphamid and 5-Flourouracil to help improve symptom burden and QoL in these patients it is hoped that this new observations. To assure comparability between the two diseases and the efects of epirubicin cyclophosphamide and 5-Flourouracil we suggest conduct further investigations and observations. Clinical Medical Biochemistry: Open Access ISSN: 2471-2663 Clinical Medical Biochemistry Hamid and Abbas Clin Med Biochem 2018 4:3 DOI: 10.4172/2471-2663.1000145 Editorial Open Access Clin Med Biochem an open access journal ISSN: 2471-2663 Volume 4 • Issue 3 • 1000145

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References 1. Wadleigh M Teferi A 2010 Classifcation and diagnosis of myeloproliferative neoplasms according to the 2008 world health organization criteria. Int J Hematol 91: 174-179. 2. Teferi A Pardanani A 2015 Myeloproliferative neoplasms: a contemporary review. JAMA Oncol 1: 97-105. 3. Mesa RA Niblack J Wadleigh M 2007 Te burden of fatigue and quality of life in myeloproliferative disorders MPDs. Cancer 109: 68-76. Citation: Hamid GA Abbas R 2018 Polycythemia Vera in a Patient with Breast Cancer. Clin Med Biochem 4: 145. doi: 10.4172/2471-2663.1000145 Page 2 of 2 Clin Med Biochem an open access journal ISSN: 2471-2663 Volume 4 • Issue 3 • 1000145

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