Amit Mehta, MD

The efficacy of androgen deprivation therapy for prostate adenocarcinoma has been known for more than 50 years.

One of the pillars in the care of hematologic malignancies is transfusion support.

One of the cornerstones of appropriate cancer treatment is staging.

A classical conundrum in medicine is the treatment of serious illness in the elderly. Various issues need to be weighed in concert, such as the patient’s overall health, acceptability of certain diagnostic or therapeutic interventions, and end-of-life wishes, among others. A case was recently seen with this backdrop, for the evaluation of a serious hematologic condition.

In the May issue this year, I presented a case of a patient found to have follicular lymphoma, who had initially presented with unusual systemic manifestations. The current case will be a follow-up of that particular patient, who suffered from a dramatic transformation to one of the most lethal hematological malignancies.

Malignant disease processes can at times present with unusual systemic manifestations, whether it is a paraneoplastic syndrome or a direct tumor-related effect. Recently, we evaluated a patient who was initially referred for one of the most common reasons for a hematology consultation, thrombocytopenia. However, it soon became apparent that the case had a few unexpected elements.

In 2008, a documentary entitled “Blood Detectives”, in reference to the work of hematologists, was produced with the support of the American Society of Hematology. The moniker “detective” is often an apt one in hematology consultations, as one generally has to have a multi-system point of view in analyzing a clinical situation. The following case is particularly instructive in that regard.

A clinical scenario that often presents to a hematologist, and perhaps equally often with a broad differential diagnosis, is that of pancytopenia. An instructive case was recently encountered that helps to illustrate the need for a detailed evaluation in such a patient.

Among the most aggressive malignancies is small cell lung cancer. The field of oncology has seen a plethora of new chemotherapeutics and treatment strategies emerge in the past several years, but such developments unfortunately have not extended to the realm of small cell lung cancer. As such, this is a disease that continues to portend a poor prognosis, and most patients present with extensive-stage disease. The following case illustrates just how acute this illness can be.

The words of the 14th-century English philosopher, William of Ockham, have classically implored physicians to search for a unifying diagnosis when encountering a patient. Therefore, one should not posit multiple disease processes when a simpler, singular explanation is evident. However, in the face of compelling evidence, multiple possible concomitant diagnoses can sometimes be at play in a patient.