Neoplasms In Elderly Research Articles

Persisting Delirium as a Presenting Feature of an Underlying Myeloproliferative Neoplasm in Elderly

A 71 year old female presented with an unusually long course of persisting delirium and a rapid downhill functional decline. She presented with progressive symptoms over a course of year with confused behaviour, sleep disturbances, irrelevant talk and restlessness followed by difficulty in walking, falls, speech disturbances, generalized weakness of six months duration and decreased appetite with urinary and stool incontinence of 2 week duration. Her lab reports had shown consistently abnormal blood counts for 4 years before hospitalisation. The abnormalities from peripheral blood smear and GBP (general blood picture) showed elevated platelet count, total leucocyte count and decreased red blood cell count and haemoglobin level. Investigations for myeloproliferative neoplasm (MPN) included the Reflex profile (JAK mutations on qualitative RT-PCR), and bone marrow biopsy (increased megakaryocytes suggestive of Essential thrombocythemia). Patient was started on Oral Hydroxyurea along with oral anti platelet and hypolipidemic drugs. Six months post chemotherapy initiation remained asymptomatic.
 
 Keywords: elderly, delirium, myeloproliferative, neoplasia.

A Case Report on Challenging Management of Multiple Neoplasms in Elderly

Multiple primary malignancies especially in the head and neck region is no longer a rare occurrence and the prevalence is increasing. They were described as synchronous when the malignancies present within 6 months of another or metachronous tumors if the subsequent malignancy presents 6 months later. Many etiologies had been hypothesised including similar carcinogens exposure, genetic susceptibility and mutation, immunodeficiency or treatment of the index tumor. Among the hypotheses, the most accepted theory was field cancerisation in which the occurrence of multiple primaries in the aerodigestive tract was due to persistent exposure of similar carcinogens through inhalation or oral intake . However the co-incidence of thyroid and aerodigestive malignancies is relatively low. Hereby we would like to report a case of a 74 years old lady with known esophageal squamous cell carcinoma presented with metachronous laryngeal squamous cell carcinoma and papillary micro carcinoma of thyroid.