We, herein, describe a 52-year-old male whom developed rhabdomyolysis and acute renal failure likely related to dasatinib shortly after the administration of treatment. After withdrawal of dasatinib, the myalgia reduced, and his CK returned to normal levels within a week. On follow-up acute renal failure did resolve without requiring dialysis, but unfortunately the patient died of severe respiratory distress. We recommend that musculoskeletal symptoms should be monitorized during therapy with dasatinib, and CML patients with musculoskeletal symptoms should have CK levels checked in order to prevent this unexpected but devastating adverse event.

In the present report, a 73 years-old male patient who developed clear cell type renal cell carcinoma (RCC) 5 years after the diagnosis of chronic lymphocytic lymphoma (CLL) and plausible explanations for this association were discussed by the authors. The incidence of CLL and RCC occurring in the same patient is higher than that expected in the general population. Various explicative hypotheses of this concurrence include treatment-related development of a second malignancy, immunomodulatory mechanisms, viral aetiology, cytokine (interleukin 6) release from a tumor, and common genetic mutations. Further investigations are warranted.

Gluten enteropatisinin ileri dönemdeki iyi bilinen komplikasyonlarından biri enteropati ilişkili lenfomadır. Hastalığın tedavisinde ve lenfoma gelişiminden korumada, gluten içeren gıdaların, ömür boyunca diyetten uzaklaştırılmaları gerekir. Glutensiz diyet sonrası, hastaların çoğunda klinik düzelme görülür ve intestinal mukozal yapı normale döner. Düzelmeyen az sayıdaki hastada, refrakter hastalık düşünülür; altta yatan bir jejunoileitis (ülseratif jejunit) veya lenfoma olabilir. Bu nedenle biz de gluten enteropatisi tanısı konan ve diyete önce cevap verip sonrasında refrakter olan, çift balon enteroskopide jejunal kitle olduğunu saptadığımız ve cerrahi rezeksiyon sonrası enteropati ilişkili T hücreli lenfoma tespit ettiğimiz olgumuzu sunmak istedik. Bu vaka bize endoskopik tetkiklerle malign görünümlü kitle lezyonu tespit edilse dahi özellikle ülser ve erozyonların varlığında inflamatuvar değişikliklerin etkisi ile alınan biyopsilerde neoplastik hücrelerin tanımlanamayabileceğini göstermiştir. Bu vakada olduğu gibi şiddetle malignite düşünülen vakalarda cerrahi ile hem tanı konabilir hem de tedavi sağlanabilir.

Immune thrombocytopenia (ITP) is an autoimmune disease characterized by peripheral thrombocyte destruction. In some autoimmune disorders, heat-shock proteins (HSP) are suggested to be an important antigenic factor. In this study, we demonstrated the serum free levels of HSP60, HSP70, anti-HSP60, and anti-HSP70 in ITP patients and healthy controls. Twenty-eight newly diagnosed ITP patients, 35 ITP patients in chronic phase, and 25 healthy controls were enrolled to this study. Serum levels of HSP60, HSP70, anti-HSP60, and anti-HSP70 were determined by the ELISA method. Serum HSP60 levels of newly diagnosed ITP patients were significantly decreased when compared with both chronic phase ITP patients and healthy controls. HSP60 levels of ITP patients (both newly diagnosed and chronic phase) with thrombocyte counts more than 30 × 10(9)/L were significantly increased compared with ITP patients with thrombocyte counts less than 30 × 10(9)/L and there was a positive correlation between thrombocyte counts and serum free HSP60 levels in ITP patients. This is the first study demonstrating the extracellular HSP levels in adult ITP patients. HSPs are shown to have a place in the pathogenesis of many autoimmune disorders. Low level of HSP60 may lead to lack of anti-inflammatory response due to less Treg activation, hence, could be a counterpart in the pathogenesis of ITP. Further studies are needed to understand the role of HSPs in the pathogenesis of ITP and whether they can be used for diagnosis, prognosis, and treatment of ITP.

e11585 Background: Anthracyclines have been widely used in the treatment of solid and hematologic malignancies. Cardiotoxicity is the most serious adverse effect that limits anthracycline treatment. Cardiotoxicity is classified by time of onset as acute, subacute and chronic. Conventional echocardiography is not sensitive enough for early detection of cardiotoxicity. In this study we aimed to evaluate anthracycline induced cardiac toxicity by speckle tracking echocardiography (STE) before left ventricular dysfunction occurs. Methods: The study included newly diagnosed breast cancer (BC) and lymphoma patients (pts) who were treated with an anthracycline containing chemotherapy (CT) regimen. They had examination with conventional echocardiyography, STE before and after anthracycline treatment. Longitudinal strain values were assessed by automated function image (AFI). Results: Thirty five pts with BC and 15 pts with lymphoma were included in the study. Ejection fraction (EF) and fractional shortening values were decreased in lymphoma pts receiving high dose anthracycline treatment (346 mg/m2) compared to BC pts receiving low dose (168 mg/m2) anthracycline. There was statistically significant increase in myocardial performance index in both groups after anthracycline CT (p=0.001 and p=0.004 for BC and lymphoma group respectively). In STE measurements, apical long axis, apikal 4 chamber and global peak systolic strain showed significant reduction in lymphoma group who had a post-therapy EF <55% (p=0.002, p=0.041, and p=0.004, respectively). Apical long axis and global peak systolic strain were also significantly decreased among the lymphoma pts with normal systolic function after CT (p=0.01 and p=0.05, respectively). Conclusions: STE can display the effect of anthracycline induced cardiotoxicity early before left ventricular dysfunction occurs. Larger prospective studies are needed to verify these data and direct the treatment of pts receiving anthracycline.

Iletisim Bilgisi / Correspondence 151 Uzm. Dr. Ugur Korkmaz, Department of Gastroenterology, Kocaeli University Medical Faculty 41300 Kocaeli Turkiye E-mail: drkorkmazugur@yahoo.com Tel: +90 262 3037383 Gelis tarihi / Received: 11.05.2013 Kabul tarihi / Accepted: 19.06.2013 Cikar Catismasi / Conflict of Interest: Yok / None Eosinophilic Gastroenteritis with Serosal Involvement and Cyclic Neutropenia

It is possible to see various hematological abnormalities in systemic lupus erythematosus (SLE). These abnormalities include anemia, thrombocytopenia, and leucopenia (1). Thrombocytosis is a condition in which there is a number of platelets over 450000 in the blood (2). This can stem from the reactively stimulation of platelet production in various diseases (iron deficiency anemia, malignances, infections, postsplenectomy or asplenic conditions), familial mutations, essential thrombocythemia, and other myeloproliferative disorders (3). Thrombocytosis due to autosplenectomy is an unusual hematologic finding in SLE. Essential thrombocythemia (ET), one of the reasons for thrombocytosis, is one of the chronic myeloproliferative disorders which JAK 2 gene mutation can be detected, and it is characterized by thrombocytosis and abnormal proliferation of megakaryocytes. Here, we have presented a patient who was observed with the coexistence of ET and SLE.

While laryngeal cancer constitutes the 2% of all types of cancers, it is the most frequently seen one in the head-neck area and smoking and alcohol are the most important factors in its etiology (1). Of all 95% of laryngeal cancers are squamous cell carcinomas (2,3). At the time of diagnosis 51% of cases have local spread and 29% of them have regional spread and 15% of them have distant metastases (1). Although laryngeal cancer often invades regional lymph nodes, it can also metastasize to distant areas such as lung, liver, mediastinum and bone. Renal metastasis is, however, very rarely observed and only 2 cases have been reported in the literature so far.

Das Multiple Myelom ist eine zu den B-Zell-Lymphomen gehörende maligne Erkrankung. Sie ist durch monoklonale Plasmazellvermehrung im Knochenmark charakterisiert. Komplette oder inkomplette monoklonale Immunglobuline werden hierdurch vermehrt produziert. Pro Jahr erkranken in Deutschland etwa 3000 Männer und 2700 Frauen neu an einem Multiplen Myelom, das nach Leukämien und Non-Hodgkin-Lymphomen die dritthäufigste hämatologische Neoplasie ist. Die Erkrankungshäufigkeit nimmt ab dem 50. Lebensjahr zu. Im Median erkranken Männer im Alter von 71 und Frauen im Alter von 73 Jahren [2]. Die Symptome der Erkrankung sind vielfältig und oft unspezifisch. Rund ein Viertel der Patienten ist bei der Diagnose beschwerdefrei. Die Diagnose erfolgt nach den aktuellen Kriterien der International Myeloma Working Group (IMWG), die im Jahr 2005 das Internationale Staging-System (ISS) publizierte, nach dem Patienten mit Multiplem Myelom durch Bestimmung des Serumalbumins und des β-2-Mikroglobulins in 3 prognostische Subgruppen eingeteilt werden können. Patienten im Stadium I (Serumalbumin ≥ 3,5 g/dl und β-2-Mikroglobulin ≤ 3,5 mg/l) haben eine mediane Überlebenszeit von 62 Monaten, Patienten im Stadium III (β-2-Mikroglobulin > 5,5 mg/l) von 29 Monaten. Zum Stadium II gehören Patienten, die nicht in Stadium I oder III eingeordnet werden können. Ihre mediane Überlebenszeit liegt bei 44 Monaten [2].