A Cornerstone of Hematological Science

The document discusses two main topics. The first part critiques a case report by Singireddy et al. on a patient with acute megakaryoblastic leukemia (AMKL), suggesting that the case likely represents an evolution of a pre-existing myeloproliferative disorder rather than de novo AMKL. The patient exhibited thrombocytosis and had a lower percentage of blasts in the bone marrow (44%) than typically seen in de novo AML, which usually exceeds 80%-90%. The presence of teardrop cells and nucleated red blood cells also pointed towards myeloid metaplasia, and the consistency of the spleen could have been used to distinguish between acute and chronic conditions. The morphology of the blasts did not have characteristic features of leukemic megakaryoblasts. The accurate identification of leukemia types is emphasized as crucial in hematological science. The second part addresses concerns about the use of finasteride, a drug approved for the treatment of male pattern alopecia (MPA), and its associated risks of male breast cancer and high-grade prostate cancer. Finasteride, which inhibits the conversion of testosterone to dihydrotestosterone, has side effects such as infertility, depression, gynecomastia, and an increased risk of cancers. The Prostate Cancer Prevention Trial (PCPT) indicated that finasteride increases the risk of high-grade prostate cancers. The document calls for future studies to evaluate whether the benefits of low-dose finasteride for hair restoration outweigh these risks. Concerns are also raised about the ease of obtaining finasteride online, which could lead to an increased incidence of these cancers.