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Introduction We describe a 35-year-old male patient showing a myeloid sarcoma (MS) of the tongue as the first manifestation of acute promyelocytic leukemia (APL). The MS can appear in all parts of the human body, but it is extremely rare in the tongue. Clinical case The main symptoms were a pain in the tongue, asthenia, gingivorrhagia, fever. We found a tumor in the tongue, which was irregular in size and located in the posterior region of the right lateral edge of the tongue. The diagnosis of MS was made by the anatomopathological and immunohistochemical study, while the definite diagnosis of APL was confirmed by the molecular test. The treatment of APL was based on the administration of trans-retinoic acid 45 mg/m2 daily continuously and daunorubicin 60 mg/m2 every other day for 4 doses, with a favorable therapeutic response to APL and MS. Conclusion Promyelocytic myeloid cells can infiltrate many organs extramedullary, such as the tongue, and this might precede bone marrow infiltration. The early identification of myeloid sarcoma allows to carry out an early treatment of the APL.

A 47-year-old Caucasian man, in good general, oral and periodontal health, presented with a non-bleeding bluish lesion on the back of his tongue, presumably due to an ecchymotic area of traumatic origin which was left untreated. The day after, other ecchymotic-type lesions on the mucous membranes of the cheeks and the upper lip, a bleeding lesion at the apex of the tongue and gingivorrhagia, along with petechiae on the back, scalp, lower limbs and feet, occurred, with rapid clinical deterioration, requiring immediate hospitalization. Oral, dermatological, and hematological evaluations lead to idiopathic thrombocytopenic purpura (ITP) diagnosis and hydrocortisone prescription, with a complete recovery in the next few days.The presented case of ITP, with early intra-oral manifestations, aimed both to emphasize the role of oral healthcare workers in theearly recognition of ITP, which may be especially relevant for those cases with extremely fast platelet depletion, high risk of internal bleeding and consequent potentially fatal complications, and in the differential diagnosis of the diseasethat may be aided by the diagnostic protocol described, and to provide dentists with recommendations on oral care management of cases of ITP, both in dental and multi-disciplinary settings.

Snakebite is an important public health problem because of its incidence, morbidity, and mortality. It may be related to climatic factors and rural habits. Snakes of the genus Bothrops are responsible for most snakebites in Brazil. The venom of these snakes has peculiar characteristics, with important proteolytic, coagulant, and hemorrhagic actions, leading to local and systemic alterations. Initial manifestations include local tissue injury, pain, swelling, bleeding, and bullous lesions that can progress to abscesses or tissue necrosis. Systemic manifestations should be carefully evaluated especially for the probability of hemorrhagic events such as epistaxis, gingivorrhagia, hematuria, and hemoptysis. Knowing the clinical manifestations of snakebites, as well as the adequate treatment, is essential. Efficient and rapid diagnosis can minimize victims’ injuries and the probability of death. The present study reports the clinical case of bleeding at a distant site from the initial site of venom inoculation after bite by a Bothrops snake, emphasizing the therapeutic approach and differential diagnosis in these cases. Los accidents de ofidios son un importante problema de salud pública, por su incidencia, morbilidad y mortalidad. Estos accidents pueden estar relacionados con factores climáticos y habitos rurales. La serpiente del género Bothrops es responsible de la maayoría de las mordeduras de serpientes que ocurrieon en Brasil. El veneno de esta serpiente tiene características peculiares, con importentes acciones proteolíticas, coagulantes y hemorrágicas, que provocam cambios locales y sistémicos. Las manifestaciones iniciales incluyen daño tisular local con dolor, edema, sangrado y lesiones ampollosas que pueden progresar a abscesos o necrosis tisular. Sin embargo, las manifestaciones sistémicas deben evaluarse cuidadosamente, especialmente por la probabilidad de eventos hemorrágicos como epistaxis, gingivorragia, hematia y hemoptysis. El conocimiento de las manifestaciones clínicas y un abordaje adecuado en la búsqueda de un diagnóstico rápido y eficiente es fundamental, minimizando así el daño a la víctima y la probabilidad de muerte. Elpresente artículo científico reporta el caso clínico de hemorragia a distancia del sitio de inoculacion inicial del veneno que ocurrío luego de un de un accidente tipo serpiente conla serpiente Bothrops, enfatizzando así el abordaje terapéutico para estos casos además del diagnóstico diferencial en este tipo de ocurrencia. O acidente ofídico é um importante problema de saúde pública, em virtude de sua incidência, morbidade e mortalidade. Tais acidentes podem estar relacionados à fatores climáticos e hábitos rurais. A serpente do gênero Bothrops é a responsável pela maioria dos acidentes ofídicos ocorridos no Brasil. O veneno desta serpente possui características peculiares, com importantes ações proteolítica, coagulante e hemorrágica, levando a alterações locais e sistêmicas. As manifestações iniciais incluem lesão tecidual local com dor, edema, sangramento e lesões bolhosas que podem evoluir para abscessos ou necrose tecidual. Porém, as manifestações sistêmicas devem ser cuidadosamente avaliadas em especial pela probabilidade de eventos hemorrágicos como epistaxe, gengivorragia, hematria e hemoptise. Torna-se imprescindível o conhecimento de manifestações clínicas e abordagem adequada na busca do diagnóstico eficiente e rápido, minimizando assim danos a vítima e a probabilidade de óbito. O presente artigo científico relata o caso clínico de hemorragia a distância do sítio inicial de inoculação da peçonha ocorrido após acidente ofídico com serpente do gênero Bothrops, enfatizando assim a abordagem terapêutica para esses casos além do diagnóstico diferencial neste tipo de ocorrência.

Background Bevacizumab (bev) is approved in Europe (EU) for first line therapy of OC patients (pts). This study aimed to evaluate the use of Bev in real life, with a focus on toxicity. Methods Representative centers in France of French regions and of mode of practice were asked to participate. From 04/13 to 02/15, among the consecutive OC pts treated in each center, were selected those who were newly diagnosed and planned to receive Bev. An independent CRA captured the clinical data at baseline, 6, 12, 18 and 36 months. Results A total of 104 centers participated: Private practice (44%), non-academic hospital (31%), academic (11%), anticancer center (14%). 1290 pts were screened, 500 registered and 468 were evaluable. Pts characteristics at baseline were: median age 65 yrs, antihypertensive therapy (26%), anticoagulant (10%), cardiac history (5%), serous histology (83%), interval surgery (47%), complete surgical debulking (74%) and carboplatin-paclitaxel chemotherapy (98%). Only 3.4% were not FIGO stage IIIB-IV. Pts received Bev at 15 mg/kg (80%) during a median of 18 cycles (10-21) and 7.8% stopped treatment for toxicity. Main toxicity was HTA requiring new therapy (38%), PRES (1.3%), venous thrombosis (5%), proteinuria (9.8%) and nephrotic syndrome (2.6%). Other toxicities mostly reported include low grade epistaxis, gingivorrhagia, arthralgia, headache and dysphonia. Gastrointestinal perforation, fistula, arterial events and grade 3-4 bleeding were very low: 0.2%, 0.8%, 0,1% and 0.2% respectively. No pts developed congestive heart failure nor died from toxicity. Median PFS was 17.4 months (IC95% [16.4-19.1]) and % of pts alive at 3 years was 62.4% (IC95 % [58.1-67.1]). Conclusions In routine practice among French centers, first-line Bev administration is consistent with the EU label in most of the cases. Efficacy and safety in the real life were in line with that reported in trials excepted for a higher incidence of observed HTA and complications, suggesting the importance of increased education on HTA monitoring. Legal entity responsible for the study ARCAGY-GINECO. Funding Roche. Disclosure A. Floquet: Advisory / Consultancy: Tesaro; Advisory / Consultancy: Clovis; Advisory / Consultancy: AstraZeneca; Travel / Accommodation / Expenses: Tesaro; Travel / Accommodation / Expenses: AstraZeneca; Travel / Accommodation / Expenses: Roche. O. Tredan: Honoraria (self): Roche; Honoraria (self): AstraZeneca; Honoraria (self): Pfizer; Honoraria (self): Novartis; Honoraria (self): Lilly; Honoraria (self): BMS; Honoraria (self): MSD. J. Alexandre: Honoraria (self): Roche; Honoraria (self): AstraZeneca; Honoraria (self): Ipsen; Honoraria (self): Novartis; Honoraria (self): PharmaMar; Advisory / Consultancy: Roche; Advisory / Consultancy: AstraZeneca; Advisory / Consultancy: Novartis; Research grant / Funding (institution): Janssen; Travel / Accommodation / Expenses: Janssen; Travel / Accommodation / Expenses: Novartis. C. Garnier Tixidre: Honoraria (self): Lilly; Honoraria (self): AstraZeneca; Advisory / Consultancy: Pfizer; Advisory / Consultancy: AstraZeneca; Travel / Accommodation / Expenses: Pfizer. P. Follana: Advisory / Consultancy: Novartis; Advisory / Consultancy: AstraZeneca; Speaker Bureau / Expert testimony: Novartis; Speaker Bureau / Expert testimony: AstraZeneca; Travel / Accommodation / Expenses: Novartis; Travel / Accommodation / Expenses: AstraZeneca; Travel / Accommodation / Expenses: Amgen; Travel / Accommodation / Expenses: Tesaro. C. Levache: Travel / Accommodation / Expenses: Sanofi. E. Pujade-Lauraine: Honoraria (self): AstraZeneca; Honoraria (self): Tesaro; Advisory / Consultancy: AstraZeneca; Advisory / Consultancy: Roche; Advisory / Consultancy: Clovis; Advisory / Consultancy: Tesaro; Advisory / Consultancy: Genmab; Advisory / Consultancy: Incyte; Advisory / Consultancy: MSD; Advisory / Consultancy: Pfizer; Research grant / Funding (institution): AstraZeneca; Research grant / Funding (institution): Roche; Research grant / Funding (institution): Tesaro; Travel / Accommodation / Expenses: AstraZeneca; Travel / Accommodation / Expenses: Roche; Research grant / Funding (institution): Tesaro. F. Selle: Honoraria (self): Roche; Honoraria (self): MSD France; Honoraria (self): PharmaMar; Honoraria (self): Tesaro; Honoraria (self): Clovis; Honoraria (self): AstraZeneca; Advisory / Consultancy: Roche; Travel / Accommodation / Expenses: Roche; Travel / Accommodation / Expenses: MSD France; Travel / Accommodation / Expenses: Tesaro; Travel / Accommodation / Expenses: AstraZeneca. All other authors have declared no conflicts of interest.